A 66 year-old male presented to emergency department with shortness of breath.

This is his initial ECG:

If you examine this ECG carefully, you will notice that is looks funny, specifically, as if all leads are reversed.

Well, after looking at his chest X-ray, these leads are most definitely reversed!

After "reversing" the leads on the ECG and getting essentially a right-sided ECG, this is what it looks like:

Teaching point:

Beware of situs inversus. Trust your gut reaction. "Reverse" your ECG as well!

Pearls for dextrocardia:

• May see a Tall R wave in V1
• Low voltage or very small R waves
• Will have Right Axis Deviation
  Differential diagnose includes: PE, COPD, RVH, LPFB, Old Lateral MI, Normal in children or very thin adult patients, Hyperkalemia, Sodium Channel Blocker Toxicity

Courtesy of Mark Ramzy and Karima Sajadi
Keywords: situs inversus, lead reversal

The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.

The images being used are for illustrative purposes only; any person depicted is a model.

 
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