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(Circulation. 2006;114:e560-e561.)
© 2006 American Heart Association, Inc.

Images in Cardiovascular Medicine

A 21-Year-Old College Student With Chest Distress and ECG Mimicking Dextrocardia

Shi-Sheng Tsou, MD; Pei-Ying Pai, MD

From the Cardiovascular Division, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.

Correspondence to Dr Pei-Ying Pai, Cardiovascular Division, Department of Internal Medicine, China Medical University Hospital, Number 2, Yuh-Der Road, Taichung, Taiwan, 403. E-mail pai119@seed.net.tw

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 21-year-old college student with a history of mitral valve prolapse had sudden left back pain followed by dull persistent chest pain and breathlessness at rest. The initial examination did not show any specific finding. The chest distress lasted for approximately 2 hours. She returned for help and underwent an ECG, which revealed normal sinus rhythm, vertical frontal axis, and loss of r-wave progression in precordial leads (Figure 1). Chest radiography revealed a pleural line over the left lung (Figure 2, arrow) and a bulla over the left lower lung (Figure 2, arrowhead). Contrast-enhanced computed tomography before drainage of the lung identified a large bulla around the border of the left ventricle (Figure 3, asterisk), extending anteriorly. After drainage with a chest tube, repeated ECG revealed normal progression of the r wave in precordial leads (Figure 4). The patient was discharged from the hospital in good condition.

View larger version (127K): [in this window] [in a new window]   Figure 1. Baseline ECG at presentation. Note loss of progression of r wave and prominent S wave from V1 to V6.

View larger version (142K): [in this window] [in a new window]   Figure 2. Chest radiograph shows a pleural line over the left lung (arrow) and a bulla over the left lower lung (arrowhead).

View larger version (149K): [in this window] [in a new window]   Figure 3. Contrast-enhanced computed tomography showing a large bulla around the border of the left ventricle.

View larger version (100K): [in this window] [in a new window]   Figure 4. ECG after drainage. Note the normal progression of the r wave from V3 to V6.

An ECG with no progression of the r wave or extreme low voltage in all . . . [Full Text of this Article]

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Circulation 2006 114: 1897. [Extract] [Full Text]