Dextrocardia is a congenital cardiac malrotation in which the heart is situated on the right side of the body (dextroversion) with the apex pointing to the right.
Dextrocardia is believed to occur in approximately 1 in 12,000 people 2.
There are two main types of dextrocardia:
- dextrocardia of embryonic arrest (also known as isolated dextrocardia)
- the heart is simply placed further right in the thorax than is normal
- commonly associated with severe defects of the heart, including abnormalities such as pulmonary hypoplasia 1
- dextrocardia with situs inversus
- dextrocardia situs inversus refers to the heart being a mirror image situated on the right side
- for all visceral organs to be mirrored, the correct term is dextrocardia situs inversus totalis
- although persons with dextrocardia situs inversus tend not have any medical problems from the disorder, some are prone to a number of bowel, oesophagal, bronchial and cardiac problems where some of these conditions can be life-threatening if uncorrected
Medical diagnosis of the two forms of congenital dextrocardia may be made by ECG.
Technical dextrocardia refers to an ECG reading that has no basis in the patient's anatomy. This apparent presentation of dextrocardia is caused usually by the technician inadvertently swapping the limb leads on a 12 lead ECG. Usually, this would show as an extreme axis deviation.
When approaching the chest radiograph in someone that appears to have dextrocardia it is important to exclude spurious dextrocardia first. This is by far the commonest cause of a dextrocardia-like appearance and is a technical error due to the radiographer/technician inadvertently flipping the image over in the mediolateral plane when processing the image. Therefore it is important to check the orientation marker on the image; usually in a spurious dextrocardia the marker will be on the 'wrong' side i.e. left marker on the right, or vice-versa.
ECG leads must be placed in reversed positions on a person with dextrocardia. In addition, when defibrillating someone 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.
- 1. Maldjian PD, Saric M. Approach to dextrocardia in adults: review. AJR Am J Roentgenol. 2007;188 (6): S39-49. doi:10.2214/AJR.06.1179 - Pubmed citation
- 2. Bohun CM, Potts JE, Casey BM et-al. A population-based study of cardiac malformations and outcomes associated with dextrocardia. Am. J. Cardiol. 2007;100 (2): 305-9. doi:10.1016/j.amjcard.2007.02.095 - Pubmed citation
- 3. Reinberg, S. A.; Mandelstam, M. E. On the Various Types of Dextrocardia and Their Diagnostics. Radiology. 1928;11 (3): 240-249. Radiology (citation) - doi:10.1148/11.3.240
- 4. Applegate KE, Goske MJ, Pierce G et-al. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. 19 (4): 837-52. Radiographics (full text) - Pubmed citation