Dextrocardia
Electrocardiographic Features
- Right axis deviation
- Positive QRS complexes (with upright P and T waves) in aVR
- Lead I: inversion of all complexes, aka ‘global negativity’ (inverted P wave, negative QRS, inverted T wave)
- Absent R-wave progression in the chest leads (dominant S waves throughout)
These changes can be reversed by placing the precordial leads in a mirror-image position on the right side of the chest and reversing the left and right arm leads.
Differential Diagnosis
Accidental reversal of the left and right arm electrodes may produce a similar picture to dextrocardia in the limb leads (but with normal appearances in the precordial leads).
Further Reading
- ECG BASICS – Waves, Intervals, Segments and Clinical Interpretation
- ECG CLINICAL CASES – Your favourite ECG’s placed in clinical context with a challenging Q&A approach
- ECG and Cardiology Eponymous Syndromes – Cheats guide to eponymous emancipation
- ECG Reference Sites on the WEB – the best of the rest
References
- Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th Edition. Saunders Elsevier 2008.
- Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
Author Credits
- Words - Ed Burns, Chris Nickson
- Pictures - Ed Burns
- Web Editing - Ed Burns, Chris Nickson
About Chris Nickson
In a patient with dextrocardia presenting with chest pain, I presume one should reverse the precordial leads in order to pick up ST changes. Should I reverse the limb leads as well? Is the interpretation e.g. LAD, RCA all the same?