J Lipid Atheroscler.  2012 Jun;1(1):29-33. 10.12997/jla.2012.1.1.29.

Successful Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in a Patient with Dextrocardia and Hypertrophic Cardiomyopathy

• Jang SY
• Jeong MH
• Jung HK
• Lee KJ
• Lee MG
• Park KH
• Sim DS
• Hong YJ
• Kim JH
• Ahn Y
• Kang JC

• KMID: 2198373
• DOI: http://doi.org/10.12997/jla.2012.1.1.29

Abstract

We report a case of a 69-year-old man presenting with acute right chest pain radiating to the right shoulder. Physical examination revealed a right sided apex beat with a palpable liver on the left side. Reversed normalizing electrocardiogram are presented, allowing for correct diagnosis of an acute anterior myocardial infarction. Dextrocardia with situs inversus is an uncommon congenital condition, the patient also diagnosed hypertrophic cardiomyopathy by two dimensional echocardiography. Successful percutaneous coronary intervention was performed and the patient was discharged after uneventful recovery.

Keyword

Dextrocardia; Myocardiac infarction; Coronary Angioplasty

MeSH Terms

Cardiomyopathy, Hypertrophic
Chest Pain
Dextrocardia
Echocardiography
Electrocardiography
Humans
Liver
Myocardial Infarction
Percutaneous Coronary Intervention
Physical Examination
Shoulder
Situs Inversus

Figure

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  Fig. 1 Standard ECG performed at a neighborhood hospital showed inverted P wave in leads I and aVL with upright P and R waves in aVR, and ST elevation in leads V1 to V3 with poor progression of R waves in the precordial leads, finding consistent with dextrocardia.

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  Fig. 2 Right sided ECG showed ST elevation in leads V1 to V3 with T wave inversion in leads V4 to V6. Note the corrected frontal plane P wave and QRS axis with R wave progression in the precordial leads.

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  Fig. 3 (A) Chest radiograph reveals right-sided heart and stomach gas suggesting situs inversus totalis. (B) Two dimensional echocardiography shows thickened ventricular septum (16mm) and it has abnormal myocardial texture. (Ao=aorta; LA=left atrium; LV=left ventricle; RV=right ventricle; VS=ventricular septum).

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  Fig. 4 Left coronary angiogram demonstrates thrombotic total occlusion proximal left anterior descending coronary artery (Arrow heads, A: right anterior oblique caudal view, C: left anterior oblique cranial view). Right coronary angiogram demonstrates no critical fixed stenosis (B: true right anterior oblique view). After successful coronary stenting shows Thrombolysis In Myocardial Infarction III flow without residual stenosis (D: left anterior oblique cranial view).

Reference

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