Dextrocardia with Situs Inversus
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《新英格兰医药杂志》
To the Editor: We question the electrocardiographic findings in the case of dextrocardia presented by Yin and Mohamed in Images in Clinical Medicine (Sept. 1 issue).1 We agree that the reverse R-wave progression across the precordial leads, with the tallest R wave in V1 progressively decreasing in amplitude in leads V2 to V6, as shown in Panel B of the original image, is typical of dextrocardia. We also agree that a normal pattern is evident in the precordial leads on right-sided electrocardiography (Panel C of the original image). However, the electrical waves should not change in the limb leads unless the placement of the electrodes was changed (Figure 1).
Figure 1. Electrocardiogram from a Typical Patient with Dextrocardia.
Limb leads are shown in the top row of the electrocardiogram and are similar to those shown in Panel B of the original image of Yin and Mohamed. The electrical waves in these leads should not have changed from Panel B to Panel C of the original image unless the limb leads were changed.
Pablo Aguiar-Souto, M.D.
Lorenzo Silva-Melchor, M.D.
Francisco J. Ortigosa-Aso, M.D.
Puerta de Hierro Hospital
28035 Madrid, Spain
aguiarsouto@hotmail.com
References
Yin LK, Mohamed AL. Dextrocardia with situs inversus. N Engl J Med 2005;353:933-933.
The author replies: Concerning the questions raised by Dr. Aguiar-Souto and colleagues about the electrical waves shown in Panel C of our image, it is true that the limb leads were changed for the purpose of comparison. This point should have been highlighted in the text.
Loh Keng Yin, M.Med.
International Medical University Malaysia
70300 Seremban, Malaysia
Figure 1. Electrocardiogram from a Typical Patient with Dextrocardia.
Limb leads are shown in the top row of the electrocardiogram and are similar to those shown in Panel B of the original image of Yin and Mohamed. The electrical waves in these leads should not have changed from Panel B to Panel C of the original image unless the limb leads were changed.
Pablo Aguiar-Souto, M.D.
Lorenzo Silva-Melchor, M.D.
Francisco J. Ortigosa-Aso, M.D.
Puerta de Hierro Hospital
28035 Madrid, Spain
aguiarsouto@hotmail.com
References
Yin LK, Mohamed AL. Dextrocardia with situs inversus. N Engl J Med 2005;353:933-933.
The author replies: Concerning the questions raised by Dr. Aguiar-Souto and colleagues about the electrical waves shown in Panel C of our image, it is true that the limb leads were changed for the purpose of comparison. This point should have been highlighted in the text.
Loh Keng Yin, M.Med.
International Medical University Malaysia
70300 Seremban, Malaysia