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ECG OF THE ECG OF THE WEEKWEEK

Dr.B.Gowrishankar.Dr.B.Gowrishankar.Prof.G.Sundaramurthy’s unit.Prof.G.Sundaramurthy’s unit.

Clinical History:Clinical History:

30 yrs old male30 yrs old male

h/o cough, cold x 3 daysh/o cough, cold x 3 days

Severe myalgia x 1 daySevere myalgia x 1 day

O/EO/E

AfebrileAfebrile

Vitals stableVitals stable

ECG SHOWSECG SHOWS

Rate-60 /minRate-60 /min

Rhythm-Normal sinus rhythmRhythm-Normal sinus rhythm

P wave-Inverted in L1, aVL. P wave-Inverted in L1, aVL. Slightly upright in aVR Slightly upright in aVR

PR interval-0.16 sPR interval-0.16 s

QRS Complex:QRS Complex:

width-0.08 swidth-0.08 saxis-RAD-100*axis-RAD-100*

Contd.,Contd.,

Configuration-Configuration-1. Reversal of QRS pattern. 1. Reversal of QRS pattern.

Tallest in V1 and progressively Tallest in V1 and progressively dimnishing to lead V6. dimnishing to lead V6.

2.slurring of downstroke of2.slurring of downstroke of QRS in L2 QRS in L2

3.’M’ pattern in L2,L33.’M’ pattern in L2,L3

Contd.,Contd.,

ST segment- Isoelectric in all leads except ST segment- Isoelectric in all leads except L2 and L3. L2 and L3.

T wave- Inverted in L1,aVL,V2-V6. T wave- Inverted in L1,aVL,V2-V6. isoelectric in aVR. isoelectric in aVR.

COMMENTS: COMMENTS: 1.Positive P waves.1.Positive P waves.2.Right axis deviation.2.Right axis deviation.3.Reversal of QRS pattern.3.Reversal of QRS pattern.

CONCLUSION:CONCLUSION:

CXR – Dextrocardia.CXR – Dextrocardia.

ECHO- Situs inversus totalis.ECHO- Situs inversus totalis.

DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS::

Reversal of limb leads:Reversal of limb leads:(Incorrectly placed arm electrodes)(Incorrectly placed arm electrodes)

The precordial leads will show The precordial leads will show normal QRS pattern.normal QRS pattern.

FEW DEFINITIONSFEW DEFINITIONS::

DEXTROCARDIA-DEXTROCARDIA-1.Isolated dextrocardia is transposition of the heart 1.Isolated dextrocardia is transposition of the heart without accompanying alteration of the abdominal without accompanying alteration of the abdominal viscera.viscera.2.Mirror-image dextrocardia-location of the heart in the 2.Mirror-image dextrocardia-location of the heart in the right side of chest, the atria being transposed and right right side of chest, the atria being transposed and right ventricle lying anteriorly and left of the left ventricle.ventricle lying anteriorly and left of the left ventricle.

DEXTROPOSITION OF THE HEART- A congenital DEXTROPOSITION OF THE HEART- A congenital anomaly in which an anatomically correct heart is anomaly in which an anatomically correct heart is displaced to the right in thoracic cavity.displaced to the right in thoracic cavity.

SIGNIFICANCE:SIGNIFICANCE:

11. When dextrocardia occurs with situs inversus . When dextrocardia occurs with situs inversus the heart is most frequently normal.the heart is most frequently normal. 22. When dextrocardia occurs without situs . When dextrocardia occurs without situs inversus, when the visceral situs is inversus, when the visceral situs is indeterminate (indeterminate (situs ambigussitus ambigus) or if isolated ) or if isolated levocardia is present complex multiple levocardia is present complex multiple anomalies are usually present.anomalies are usually present.

33. Dextrocardia with situs solitus or situs . Dextrocardia with situs solitus or situs ambigus is less common and the incidence of ambigus is less common and the incidence of CHD is extremely high, probably 90%or greater.CHD is extremely high, probably 90%or greater.

THANK YOUTHANK YOU