A 59-year-old man presents to the emergency department with anaphylaxis from a bee sting. Describe and interpret his initial 12-lead electrocardiogram:
INTERPRETATION:
- 64 bpm
- Sinus rhythm
- Right axis deviation (153°)
- Positive QRS complexes in aVR
- Global negativity in lead I
- QRS 82 ms
- Low QRS voltages
- Absent R wave progression in precordial leads with dominant S waves throughout
- T wave flattening in precordial and lateral leads
DIAGNOSIS:
Patient confirms that he has situs inversus, and therefore dextrocardia!
ECG repeated with right-sided chest electrodes and reversing the left and right limb electrodes:
INTERPRETATION:
- Ventricular rate 62 bpm
- Sinus rhythm
- Normal QRS axis (22°)
- QRS duration 84 ms
- Normalised QRS voltages throughout the precordial leads with normal R wave progression
- Low QRS voltages in limb leads
- Non-specific T wave in the inferolateral leads
DIAGNOSIS:
Essentially normal 12-lead electrocardiogram in a patient with Situs Inversus.
