Dextrocardia classification , presentation, significance and ECG features - By Dr. Vaibhav Yawalkar , MD

1. Dextrocardia
Dr. Vaibhav Yawalkar, MD

2. Presentation:
•Depends on type and associated cardiac anomalies.
•Dextrocardia with other heart defects is more
common than dextrocardia with normal heart.
•Most severe form is “Heterotaxy”, in which multiple
other organs are not at their normal anatomical
locations and/or malformed.

3. Presentation:
•These cases usually present in early childhood with
heart failure, or other organs related symptoms,
mostly recurrent fulminant infections due to asplenia.
•Patients with Dextrocardia & no other cardiac
anomalies are asymptomatic and often detected on
clinical or radiological examination done for unrelated
illness.

4. Terminology:
•Dextroversion or Dextrorotation:
Rotation of heart around vertical axis, such that left ventricle
lies anterior to Right ventricle.
•Dextroposition:
Anatomically normal heart is shifted to right due to some
acquired pathology, such as Right Lung fibrosis , collapse or
Left sided massive pleural effusion or pneumothorax etc.
•Dextrocardia:
Mirror image anatomical position along vertical axis.

6. Types:
•Dextrocardia of Embryonic arrest:
Also called as Isolated Dextrocardia, almost always associated
with severe cardiac defects.
•Dextrocardia with Situs Inversus:
 Generally without any cardiac defects.
 Autosomal Recessive condition.
 If Situs inversus is with Levocardia ,it is almost always
associated with severe cardias defects.
• Overall Incidence of Dextrocardia: 1 in 12000 people

7. Etiology:
•Genetic Predisposition (Autosomal Recessive Situs
Inversus)
•Problems during organogenesis and rotation of
viscera.
•Association with Kartagener syndrome (50% patients
has situs Inversus Dextrocardia)

8. ECG Features:

9. aVR
= Normal aVL aVL
= Normal aVR
aVF = aVF
Lead I =
Reverse of Normal Lead I
Lead III = Lead II Lead II = Lead III

10. ECG Features:
• Right Axis deviation
• aVR :
Upright P & T wave
Positive QRS
• Lead I :
Inverted P, T, and QRS
• Chest Leads:
Absent “r” progression
Dominant “s” wave throughout.

12. Significance:
• Recognising correct anatomy during surgical procedure.
• Subconsciously labelling on Chest X-ray may be ignored by
physicians and they may hold it incorrectly to offset for
dextrocardia, which leads to wrong localization of lung
pathology if clinical findings are subtle.
• Maintaining Base to Apex position of electrodes during
Electrical cardioversion. (?)
• While recording ECG in known dextrocardia patient,
Reverse Limb leads as well as chest leads, especially for
localising current of injury.

13. NORMAL IN DEXTROCARDIA
RA
LA
RF LF

14. V 2 V 1