Non–ST-Segment Elevation Myocardial Infarction in a Patient With Dextrocardia

Figures

• 

  Figure 1. Chest Radiography Demonstrating Situs Inversus Totalis This posteroanterior chest x-ray confirms the diagnosis of dextrocardia with situs inversus totalis. A standard chest x-ray was performed on admission. The cardiac silhouette is located on the right side of the chest. Note the right-sided aortic arch (arow) and the gastric bubble (G) located in the right upper quadrant, confirming the complete transposition of thoracic and abdominal viscera (situs inversus totalis). Recognition of this anatomy is crucial for interpreting subsequent diagnostic tests and guiding cardiac catheterization.

• 

  Figure 2. ECG Findings in Non–ST-Segment Elevation Myocardial Infarction With Dextrocardia (A) Standard electrocardiogram (ECG) demonstrates a positive QRS complex in lead aVR, extreme right-axis deviation, and abnormal precordial R-wave progression. (B) ECG recorded with limb-lead reversal and right-sided precordial lead placement demonstrates persistent right-axis deviation, more typical R-wave progression, and ST-segment depression in right-sided precordial leads (V2R and V6R). Appropriate lead reorientation is essential for accurate ischemia assessment in patients with dextrocardia.

• 

  Figure 3. RCA Angiography Before and After Intervention Angiographic results illustrating successful percutaneous coronary intervention of the right coronary artery (RCA) in a patient with situs inversus and dextrocardia. Left image shows the RCA before revascularization, demonstrating complete occlusion with no distal flow (TIMI flow grade 0). Right image shows the same vessel after revascularization with sequential drug-eluting stent implantation, with restoration of normal distal flow (TIMI flow grade 3). Images are shown in a fluoroscopic projection equivalent to a standard left anterior oblique view in normal cardiac anatomy, accounting for mirror-image orientation in dextrocardia.