Isolated Dextrocardia with Right Ventricular Dominance

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ELECTROCARDIOGRAPHIC BRIEFS Isolated Dextrocardia with Right Ventricular Dominance

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Edu:ard L. Schwartz, M.D., F.C.C.P.

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The electrocardiogram of isolated dextrocardia has been described frequently and is usually easily diagnosed. In the following case of isolated dextrocardia, congenital pulmonary stenosis with right ventricular hypertrophy was present. The combined anatomic abnormalities produced normalization of the electrocardiogram. Case Report: A 19-year-old man came to the author's attention following interpretation of his electrocardiogram as part of a pre-employment examination. A history of dextrocardia and catheter-proved congenital pulmonary stenosis was obtained. Dextrocardia and right ventricular enlargement were verified on chest x-ray examination. The electrocardiogram observed by the author is shown in Figure l. Fi!,'lJre 2 reveals an electrocardiogram which has been technically distorted by the reversal of the right and left arm electrodes and by the recording of right sided precordial leads. Attention is directed to the absence of the usual diagnostic electrocardiographic features of dextrocardia or right ventricular hypertrophy in Figure 1. There is normalization of the tracing with only non-diagnostic ST-T and P wave abnormalities. By technically eliminating the contribution to the electrocardiogram due to the dextrocardia (Fig 2), the pattern of right ventricular hypertrophy (systolic overload type) is plainly visible.

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FIGURE 2. Electrocardiogram consistent with right ventricular hypertrophy (systolic overload type).

Left Atrial Infarction Eduardo Bersano, M.D.,o Carlos Dicosky, M.D.,o and Henry A. Zimmerman, M.D., F.C.C.P. oo

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It is important to bear in mind that dextrocardia can exist without typical changes on the electrocardiogram. When this occurs an additional cardiac lesion producing right ventricular dominance should be suspected.

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v4 FIGURE 1. Electrocardiogram revealing non-specific ST-T and P wave abnormalities. °From the Department of Internal Medicine. Nassau Hospital, Mineola, New York.

DIS. CHEST, VOL. 54, NO.3, SEPTEMBER 1968

Atrial infarction can be diagnosed electrocardiographically by alterations of the ST. segment and Ta wave, by changes of the P wave and by disturbances in the formation and conduction of atrial stimuli.I· 3 •6 •7 ,9 The first manifestation of injury consists of a depression or elevation of the ST. segment; following, there is a transformation of the displaced ST. segment into a sharp T. wave whose polarity is opposite that of the P wave. These changes are the expression of atrial myocardial injury and ischemia. 1i P wave changes consist of broadening, inversion, diminution or increase in the amplitude, slurring, notching and development of "M" or "w" shapes. 4 •5 •10 Disturbances of atrial rhythm and conduction, mainly atrial Hutter or fibrillation, which develop suddenly during the initial stages of myocardial infarction, should lead one to suspect the existence of atrial infarction. 8 o Fellows,

Marie L. Coakley Cardiovascular Laboratory. St. Vincent Charity Hospital, Cleveland, Ohio. o o Director, Marie L. Coakley Cardiovascular Laboratory. St. Vincent Charity Hospital, Cleveland, Ohio. Aided by a grant from the United Health Fund-Ashland, Ohio.

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