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| '''For the WikiDoc page for this topic, click [[Eisenmenger's syndrome|here]]''' | | '''For the WikiPatient page for this topic, click [[Dextrocardia (patient information)|here]]''' |
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| {{CMG}}
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| '''Associate Editors-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, MBBS]] [[mailto:psingh@perfuse.org]]; {{CZ}}; [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]; Claudia Hochberg, M.D.
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| '''Assistant Editor-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [[mailto:kfeeney@perfuse.org]]
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Dextrocardia | | | Name = Dextrocardia | |
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| MeshNumber = C14.240.400.280 | | | MeshNumber = C14.240.400.280 | |
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| | {{Dextrocardia}} |
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| {{WikiDoc Cardiology Network Infobox}}
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| {{SI}}
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| {{CMG}}
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| '''Associate Editor-in-Chief:''' [[User:KeriShafer|Keri Shafer, M.D.]] [mailto:kshafer@bidmc.harvard.edu]
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| ==Overview==
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| '''Dextrocardia'' refers to the heart being situated on the right side of the body. If all visceral organs are mirror reversed, the correct term is Dextrocardia Situs Inversus Totalis. Individuals with both dextrocardia and situs inversus have a lower incidence of congenital heart defects than do people with only one of the two conditions.
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| ==History==
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| Dextorocardia was decribed by Fabricious in 1606. Situs inversus with dextrocardia (totalis) was first described by Severinus in 1643.
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| ==Epidemiology==
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| Dextrocardia is believed to occur in approximately 1 in a 100 people, while 1 in 1,000 of these will have [[Situs Inversus]].
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| [[Kartagener’s syndrome]] occurs in approximately 1 in 15-25 of patients with Totalis (situs inversus with dextrocardia). Kartagener Syndrome (KS), is a rare autosomal recessive genetic disorder caused by a defect in the action of the tiny hairs (cilia) lining the respiratory tract. Specifically, it is a defect in a gene coding for left-right dynein (lrd), a key structural protein in cilia.<ref>Cleveland JC Jr, Shroyer AL, Chen AY, et al: Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001;72: 1282-1289.</ref>
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| ==Pathophysiology==
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| Dextrocardia is not associated with any medical sequela.
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| ==Diagnosis==
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| ===Electrocardiogram===
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| It is possible to distinguish lead reversal and [[dextrocardia]] by watching the precordial leads. Dextrocardia will show an R wave inversion, whereas lead reversal will not.
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| The bottom EKG shows marked [[right axis deviation]] and loss of voltage across the precordium. There are also inverted [[P wave]]s in leads I and aVL. The differential for inverted P waves in lead I and aVL is Dextrocardia vs Reversed Arm Leads. Since there is loss of voltage across the precordium this is Dextrocardia.
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:cableReversal1.png|Right and left arm lead reversal can be distinguished from the (much rarer) dextrocardia by looking at the precordial R wave progression.
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| Image:Dextrocardia.jpg|EKG in a patient with dextrocardia. This EKG shows marked right axis deviation and loss of voltage across the precordium. There are also inverted p waves in leads I and aVL. The differential for inverted p waves in lead I and aVL is Dextrocardia or Reversed Arm Leads. Since there is loss of voltage across the precordium this is Dextrocardia.
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| </gallery>
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| </div>
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| ===Chest X Ray===
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| Shown to the right is a chest X ray in a patient with Dextrocardia. Note that the heart is on the right side of the chest.
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Dextrocardia cxr.jpg|
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| </gallery>
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| </div>
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| ===Coronary Angiography===
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| * Dextrocardia Angiogram 1
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| <youtube v=r570-FIuVCc/>
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| * Dextrocardia Angiogram 2
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| <youtube v=Kd1LjLJWvTQ/>
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| * Dextrocardia Angiogram 3
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| <youtube v=rIQqCAgLk1Y/>
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| ===Fetal and Postnatal Diagnosis by Ultrasound, Magnetic Resonance Imaging (MRI), and Chest X Ray===
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| The presenting twin of this 22 week gestation has dextrocardia. Images supported by NIH grant NS37945
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Dextrocardia prenatal ultrasound.jpg
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| Image:Dextrocardia mri1.jpg
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| Image:Dextrocardia mri2.jpg
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| </gallery>
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| </div>
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| <div align="left">
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| <gallery heights="175" widths="175">
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| Image:Dextrocardia mri3.jpg
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| Image:Dextrocardia postnatal.jpg
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| </gallery>
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| </div>
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| ===Performing an EKG===
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| ECG leads must be placed in reversed positions on a person with Dextrocardia.
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| ===Defibrillating a Patient with Dextrocardia===
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| When defibrillating a patient with dextrocardia, the pads should be placed in reverse positions. That is, instead of upper right and lower left, pads should be placed upper left and lower right.
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| ==Treatment==
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| ===Coronary Artery Bypass Grafting===
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| CABG can be performed in the patient with dextrocardia. A right [[internal mammary artery]] may be used as a conduit to the [[left anterior descending artery]].<ref>Irvin RG, Ballenger JF: Coronary artery bypass in a patient with situs inversus. Chest 1982;81:380-381.</ref> <ref>Mesa JM, Aroca A, Frutos A, et al: Situs inversus and myocardial revascularization: Case report. J Cardiovasc Surg 1995;36: 571-572.</ref> <ref>Cleveland JC Jr, Shroyer AL, Chen AY, et al: Off-pump coronary artery bypass grafting decreases risk-adjusted mortality and morbidity. Ann Thorac Surg 2001;72: 1282-1289.</ref>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| ==Additional resources==
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| * {{LoyolaMedEd|GrossAnatomy/thorax0/Heart_Development/Dextrocardia.html}}
| | {{WikiDoc Help Menu}} |
| * [http://www.rch.org.au/cardiology/health-info.cfm?doc_id=3538 Overview at rch.org.au]
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| ==Additional Reading==
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| * Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
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| {{Electrocardiography}}
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| {{Congenital malformations and deformations of circulatory system}}
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| {{SIB}} | |
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| [[Category:Cardiology]] | | [[Category:Cardiology]] |
| [[Category:Congenital heart disease]] | | [[Category:Congenital heart disease]] |
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| [[de:Dextrokardie]]
| | [[Category:Pediatrics]] |
| [[es:Dextrocardia]]
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| [[pl:Dekstrokardia]] | |
| [[tr:Dekstrokardi]] | |
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| {{WikiDoc Help Menu}}
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| {{WikiDoc Sources}}
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