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This is a routine EKG on a 46 year old woman admitted with left iliac fossa abdominal pain. The surgical house officer asks you if the patient has cardiac tamponade in view of the small complexes and distant heart sounds. What does the EKG show and what is your diagnosis? Rate: 100 Rhythm: sinus rhythm Axis: right axis deviation P: inverted in lead I and AVL PR: normal QRS: narrow, R waves are progressively smaller across chest leads EKG Diagnosis: dextrocardia (normal EKG) Clinical Diagnosis: 1) dextrocardia 2) Possible appendicitis Practice Points: - The inverted p waves in I are a clue to the diagnosis. Normally, p waves are upright in lead I. The other typical feature of dextrocardia is the progressive loss of R-wave height across the chest leads due to the increasing electrode distance from the myocardium - The most common cause of inverted p waves in I is the fact that the EKG has been recorded incorrectly (right and left arm leads have been transposed) - Dextrocardia may be associated with situs inversus in which the thoracic and abdominal viscera are also on the reverse side. This has clear implications for the differential diagnosis of abdominal pain. |