Spotter of the week

15 NOV 2014

What Renuka Says Spotter Series ...

Spotter: Dr.Abbas Ali Khatai, MEM PGY-I

Case -
A 68 year old male patient came to the ED with complaints of left sided chest pain……

ECG
  
DEXTROCARDIA -
Right axis deviatioin
Positive QRS complexes(with upright P and T waves )n aVR.
Inversion of all complexes,aka ‘global negativity’ (inverted P wave,negative QRS,inverted T wave)
Absent R-wave progression in the chest leads(dominant S waves throughout)

CXR

WHAT IS IT??
Dextrocardia is a condition where the heart is located on the right side of the body.
Approximately 1 in 12000 people have it.
Result of birth defect.
Does not usually case any problems.
Usually goes undiagnosed until the patient gets his first ECG or CXR.

HOW DO YOU TAKE AN ECG??
Put the leads on the patient in a mirror image of the normal location.
Left and right limb leads should be swapped for both arms and legs.
Chest leads should run along the right side of the chest rather than the left.

The patient had acidity from last nights marriage feast….
   …..but I learned something new!