Coronary heart disease in situs inversus totalis

doi:10.1016/0002-9149(73)90341-X

The American Journal of Cardiology

Volume 31, Issue 5, May 1973, Pages 666-669

https://doi.org/10.1016/0002-9149(73)90341-X Get rights and content

Abstract

In patients with dextrocardia as a part of situs inversus totalis, coronary heart disease may occur with similar frequency and manifestations as in the general population. Diagnostic problems arise from the altered cardiovisceral relation; when these are recognized, coronary heart disease can be defined by the usual criteria. The use of electrocardiographic and vectorcardiographic tracings with right-left reversal of all leads in patients with dextrocardia allows the recognition of abnormalities on the basis of standard criteria. Seven cases are reported, 1 followed up clinically and 6 studied at autopsy.

References (25)

GT Gau et al.
The effect of electrode position on a modified Frank electrovectorcardiographic lead system
R Van Praagh et al.
Anatomic types of congenital dextrocardia: diagnostic and embryologic implications
Amer J Cardiol
(1964)
AJ Moss et al.
Heart Disease in Infants, Children, and Adolescents
EA Cockayne
The genetics of transposition of the viscera
Quart J Med
(1938)
J Torgersen
Genie factors in visceral asymmetry and in the development and pathologic changes of the lungs, heart and abdominal organs
Arch Path (Chicago)
(1949)
RA Arcilla et al.
Congenital dextrocardia: clinical, angiocardiographic, and autopsy studies on 50 patients
J Pediat
(1961)
RH Feldt et al.
Incidence of congenital heart disease in children born to residents of Olmsted County, Minnesota, 1950–1969
JD Keith et al.
Heart Disease in Infancy and Childhood
SM Ayres et al.
Dextrorotation of the heart: an angiocardiographic study of forty-one cases
Circulation
(1963)
LP Elliott et al.
X-ray Diagnosis of Congenital Cardiac Disease

JS Hanson et al.

Primary and secondary dextrocardia: their differentiation and the role of cineangiocardiography in diagnosing associated congenital cardiac defects

Amer J Cardiol

(1961)

R Adams et al.

Situs inversus, sinusitis, bronchiectasis: a report of five cases, including frequency statistics

J Thorac Cardiovasc Surg

(1937)

Cited by (79)

Primary PCI for acute myocardial infarction in a patient with situs inversus totalis and dextrocardia
2021, Journal of Cardiology Cases
Citation Excerpt :
Estimated prevalence of situs inversus dextrocardia in the general population is about 1:8000 to 1:10,000. Risk of coronary atherosclerosis and acute myocardial infarction (MI) in this population is similar to that of the general population [1]. There are few case reports of acute MI in dextrocardia but detailed descriptions of electrocardiogram (ECG) identification and approach to emergency primary percutaneous coronary intervention (PCI) are lacking.
Situs inversus totalis with dextrocardia is a rare congenital occurrence. Risk of coronary atherosclerosis and acute myocardial infarction in this subset is similar to that in the general population. Diagnosing myocardial injury in time, and executing primary percutaneous coronary intervention (PCI) successfully in these patients is challenging given that physicians are rarely attuned to recognizing the electrocardiographic changes of acute coronary syndromes in this anatomy and interventional cardiologists are not routinely accustomed to working with the angiographic projections in this unique subset. Here, we describe electrocardiogram identification and an approach to primary PCI in one such patient. We have also attempted to simplify and refine primary PCI in this subset by introducing postero-anterior projection single inversion technique for suitable lesions in suitable vessels in this unique subset.
<Learning objective: Angioplasty of a diseased left anterior descending artery (LAD) in situs inversus dextrocardia can be simplified by using the postero-anterior (PA) projection predominantly, [thus eliminating the need for the need for right anterior oblique/left anterior oblique swapping (the reverse technique)], and utilizing only right-left reversal by activating horizontal sweep reverse option while filming the proximal (caudal tilt) and distal LAD (cranial tilt) to reorient the vessel in a viewer friendly equivalent. This we called the PA projection-single inversion technique for LAD in situs inversus dextrocardia.>
Acute coronary syndrome in Dextrocardia
2021, American Journal of Emergency Medicine
Citation Excerpt :
Subsequently, dextrocardia does not appear to be an independent risk factor for the development of CAD compared to the general population [1]. In one case series studying sudden cardiac death in dextrocardia, obesity, hypertension, and DM were prevalent risk factors [4]. In patients without an established diagnosis of dextrocardia, identifying ACS is challenging due to the left-right symmetry abnormalities which leads to a contralateral symptomatology [1].
Situs inversus with dextrocardia is both a clinical and diagnostic challenge for emergency physicians to properly identify acute coronary syndrome. While dextrocardia itself does not independently increase the risk of coronary artery disease, mirrored symptoms, including right-sided and rightward radiating chest pain in any patient with cardiac risk factors should raise suspicion for acute coronary syndrome. In patients with a reversed cardiac silhouette on a chest radiograph, a reversed electrocardiogram, to include both the precordial and limb leads, is necessary to evaluate for cardiac ischemia in presumed dextrocardia. The authors present a case of a 66-year-old man with dextrocardia who presented with shortness of breath and hypotension. Rapid application of a reversed electrocardiogram resulted in the timely diagnosis of ST-segment elevation myocardial infarction and activation of the cardiac catheterization laboratory resulting in the preservation of this patient's life.
Acute myocardial infarction in dextrocardia — A diagnostic and therapeutic challenge. Can dextrocardia be a risk factor?
2018, Journal of Cardiology Cases
Citation Excerpt :
Although there are case reports which showed myocardial infarction in dextrocardia, they already had established risk factors for coronary artery disease. In one autopsy study by Hynes et al., who studied six patients with situs inversus totalis, five patients died suddenly and four of these cases had severe coronary artery disease [8]. As the mean age of this study was 56 years and three patients had concomitant hypertension, the results can be confounded.
Acute myocardial infarction in dextrocardia may present several challenges either in electrocardiographic diagnosis or coronary intervention or both, due to abnormal location of the heart, mirror images o the aorta and its branches, and abnormal coronary origin and orientation. Also, dextrocardia as a risk factor for coronary artery disease is less well established. We report the case of a young patient with dextrocardia and situs inversus without any risk factor who presented with acute extensive anterior wall myocardial infarction diagnosed after lead reversal and who successfully underwent coronary intervention using “double inversion technique”.
<Learning objective: Dextrocardia imposes a big challenge in diagnosing acute myocardial infarction on electrocardiography (ECG). Both limb and precordial leads should be reversed to reveal all ECG changes. Also because of the unfamiliar anatomy of coronaries and great vessels, double inversion technique is useful during the intervention. It is not well-established whether dextrocardia can be a risk factor for myocardial infarction.>
Triple vessel percutaneous coronary intervention in a patient with situs inversus dextrocardia using a transradial approach
2016, Indian Heart Journal
Citation Excerpt :
The estimated incidence is 1:8000 to 1:10,000 live births.1 These individuals usually have structurally normal hearts, normal longevity and coronary artery disease frequency similar to the general population.2 There are isolated reports of coronary angiography (CAG) and percutaneous coronary intervention (PCI) in these patients.3–8
Myocardial infarction in a young woman with internal transposition (clinical case)
2023, Clinical Review for General Practice
Edge-to-Edge Mitral Valve Repair in a Patient with Situs Inversus
2023, Complex Cases in Structural Heart Intervention

View all citing articles on Scopus

View full text

Case reportCoronary heart disease in situs inversus totalis

Abstract

The effect of electrode position on a modified Frank electrovectorcardiographic lead system

Anatomic types of congenital dextrocardia: diagnostic and embryologic implications

Amer J Cardiol

Heart Disease in Infants, Children, and Adolescents

The genetics of transposition of the viscera

Quart J Med

Genie factors in visceral asymmetry and in the development and pathologic changes of the lungs, heart and abdominal organs

Arch Path (Chicago)

Congenital dextrocardia: clinical, angiocardiographic, and autopsy studies on 50 patients

J Pediat

Incidence of congenital heart disease in children born to residents of Olmsted County, Minnesota, 1950–1969

Heart Disease in Infancy and Childhood

Dextrorotation of the heart: an angiocardiographic study of forty-one cases

Circulation

X-ray Diagnosis of Congenital Cardiac Disease

Primary and secondary dextrocardia: their differentiation and the role of cineangiocardiography in diagnosing associated congenital cardiac defects

Amer J Cardiol

Situs inversus, sinusitis, bronchiectasis: a report of five cases, including frequency statistics

J Thorac Cardiovasc Surg

Case report
Coronary heart disease in situs inversus totalis