Dextrocardia

Relevant physical signs

• Peripheries
  • No stigmata of infective endocarditis
  • Regular pulse
  • No clubbing / cyanosis
  • No conjunctival pallor
  • Jugular venous pulsation not raised
• Precordium
  • Apex beat palpable on the right side
  • Heart sounds louder on the right than on the left
  • Listen carefully for any other added sounds
• Lungs
  • Coarse crepitations of bronchiectasis (Kartagener’s syndrome)
    • Primary ciliary dyskinesia (autosomal recessive) resulting in bronchiectasis
    • Associated with situs inversus, bronchiectasis and sinusitis
• Offer to examine abdomen for situs inversus

Investigations

• Chest radiograph to look for dextrocardia
• Electrocardiogram
  • Inverted P waves and QRS complexes in lead I
  • Reverse R wave progression – tallest in V1 and smaller towards V6
  • Normal ECG with right-sided chest leads

Management

• No specific management necessary for isolated dextrocardia
• Kartagener’s syndrome: see bronchiectasis