Dextrocardia and proper lead placement

Dextrocardia is a condition where the heart is located on the right side of the body, as opposed to the left. This condition is typically the result of a birth defect and doesn’t usually cause any problems. Patients with Dextrocardia are often undiagnosed until they receive their first chest x-ray or ECG. Depending on the person’s health history, they may go until early adulthood without knowing. Knowing that your patient has Dextrocardia will alleviate a lot of headache and confusion both in the pre-hospital setting and in the ER.

Below is an example of a chest x-ray of a patient diagnosed with Dextrocardia

When you encounter patient with Dextrocardia, it is important to place the ECG leads backwards. For example, the left-limb leads should be placed on the right side. If the leads are placed in their traditional location, the ECG will show inverted P and T waves.

Below is an ECG revealing Dextrocardia (The leads are in their traditional locations)

There is a lot documentation out there that suggests that defibrillator paddles / pads should be placed on the opposite side when defibrillating patients with Dextrocardia. However, there are also studies that show that paddle / pad placement doesn’t make much of a difference. If in doubt, contact your medical director and ask for guidance before being confronted with this situation.

Dextrocaria can be detected in a 12-lead ECG. An alerting sign is a P and QRS inversion in lead 1. If you encounter this, first check your limb leads to assess proper placement, then contact medical control to relay your findings. Do not assume that the patient has the defect if they have not been diagnosed by a physician.

Other than ECG placement and defibrillation, your treatment of patients with Dextrocardia doesn’t change.

If you have any questions, or have any more information, please comment below or e-mail me.


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