Is This Right? (… or Is It Left?)
An asymptomatic 57-year-old woman presented with dextrocardia and situs inversus.
The surface ECG (Figure⇓, panel A) reveals a rightward QRS axis. Poor R-wave progression is present in the standard precordial leads, whereas the right chest leads (rV1 through rV6), conversely, demonstrate progression of the R wave. The repolarization abnormality seen in leads rV4 through rV6 is secondary to left ventricular hypertrophy related to long-standing systemic hypertension.
The posteroanterior chest radiograph (B) is a mirror image of the normal radiograph, with the heart located at the right hemithorax, the ascending aorta (arrows) and aortic knuckle forming the left heart border, and the left hemidiaphragm positioned higher than the right hemidiaphragm. The letters L and R indicate the patient’s left and right side, respectively.
The coronal MRI (C) of the chest and upper abdomen demonstrates the relationship of the thoracic and abdominal organs. AAo indicates ascending aorta; LV, left ventricle; PA, pulmonary artery; and RA, right atrium.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
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