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Image challenge
A strange heart
  1. Marinha Silva1,
  2. Vitor Hugo Pereira2,3,
  3. Alexandra Sousa4,5
  1. 1 Internal Medicine, Hospital Santa Maria Maior EPE, Barcelos, Portugal
  2. 2 Cardiology, Hospital de Braga, Braga, Portugal
  3. 3 University of Minho Life and Health Sciences Research Institute, Braga, Portugal
  4. 4 Cardiology, Hospital Santa Maria Maior EPE, Barcelos, Portugal
  5. 5 Medicine Department, Faculty of Medicine, Porto, Portugal
  1. Correspondence to Dr Marinha Silva, Medicina Interna, Hospital Santa Maria Maior EPE, Barcelos 4750-333, Portugal; marinhasilva{at}gmail.com

https://doi.org/10.1136/heartjnl-2021-320677

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    Clinical introduction

    A woman in her 60s with a medical history of hypertension, dyslipidaemia, overweight and chronic plaque psoriasis was referred to cardiology for symptoms of dyspnoea on moderate exertion. Physical examination was unremarkable except for a significantly displaced apical impulse to the left. The transthoracic echocardiography revealed a cardiac malposition with posterior apex and a right-positioned aortic arch. The ECG showed sinus rhythm, right axis deviation and signs of enlargement of the right chambers. A cardiac magnetic resonance (CMR) imaging was then performed (figure 1A,B …

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    Footnotes

    • Contributors MS: design, acquisition, analysis and interpretation of data for the work, and manuscript drafting. VHP, AS: final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.