Acute myocardial infarction in a patient with

Journal of Community Hospital Internal Medicine Perspectives

ISSN: (Print) 2000-9666 (Online) Journal homepage: http://www.tandfonline.com/loi/zjch20

Acute myocardial infarction in a patient with dextrocardia and successful angioplasty Bishnu H. Subedi To cite this article: Bishnu H. Subedi (2017) Acute myocardial infarction in a patient with dextrocardia and successful angioplasty, Journal of Community Hospital Internal Medicine Perspectives, 7:6, 378-380, DOI: 10.1080/20009666.2017.1396168 To link to this article: https://doi.org/10.1080/20009666.2017.1396168

© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. View supplementary material

Published online: 14 Dec 2017.

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Date: 14 December 2017, At: 16:41

JOURNAL OF COMMUNITY HOSPITAL INTERNAL MEDICINE PERSPECTIVES, 2017 VOL. 7, NO. 6, 378–380 https://doi.org/10.1080/20009666.2017.1396168

CLINICAL IMAGING

Acute myocardial infarction in a patient with dextrocardia and successful angioplasty Bishnu H. Subedi Division of Cardiology, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA ARTICLE HISTORY

ABSTRACT

Downloaded by [191.101.91.124] at 16:41 14 December 2017

A 48-year-old man with dextrocardia presented with atypical chest pain for 2 hours. Rightside ECG showed convex upward ST elevations in leads V4 and V5. Coronary angiogram showed complete occlusion of mid portion of the left anterior descending artery (LAD). Several attempts at engaging the left main origin was successful and the LAD was opened with placement of a drug-eluting stent. The post-procedure course was uneventful, and he was discharged home two days later.

Received 23 June 2017 Accepted 17 Oct 2017 KEYWORDS

Kartagener syndrome; Dextrocardia; ST-elevation myocardial infarction; coronary angiogram; angioplasty

1. Brief Case Description

Declaration of interest

A 48-year-old Indian male with a history of Kartagener’s syndrome and situs inversus with dextrocardia (chest X-ray, Figure 1) presented with atypical chest pain for 2 hours. His initial blood pressure was 118/76 mmHg, and heart rate was 62 beats/min. Physical exam revealed no evidence of lung crackles, third heart sound or jugular venous distension. Twelve-lead left-side electrocardiogram (EKG) (Figure 2) showed sinus rhythm, inverted P waves in leads I and AVL, poor R wave progression in precordial leads (V1–V6), the features consistent with dextrocardia. Subsequent right-side EKG showed convex upward ST elevations in leads V4 and V5 (Figure 3). He was emergently taken to Cardiac Cath lab. Coronary angiogram via right femoral access showed complete occlusion of mid portion of left anterior descending artery (LAD) (Video 1). Several attempts at engaging the left main with 'six French JL (Judkins Left) four' catheter was successful and the LAD was opened (Figure 4) with subsequent placement of a 3mm x 32mm drugeluting stent. The right coronary artery was engaged with 'six French JR (Judkins Right) four' catheter. Left circumflex and right coronary arteries were normal and did not require interventions. Post-procedure course remained uneventful, and he was discharged home two days later.

No potential conflict of interest was reported by the author.

Funding No grants, contracts or supports for submission of this manuscript.

Figure 1. Dextrocardia with situs inversus. Portable chest X-ray (Anteroposterior view) showing the heart above right hemidiaphragm with apex near right rib cage and stomach gas bubbles beneath it.

CONTACT Bishnu H. Subedi [email protected] Division of Cardiology, New York-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA Supplemental data for this article can be accessed here. © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Figure 2. Initial ECG of the patient. Sinus rhythm, dextrocardia. Inverted P waves in lateral leads including I and AVL and poor R-waves progression in chest leads V1–V6.

Figure 3. Right-sided 12-lead ECG of the same patient showing convex upward ST elevations in leads V4 and V5.


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B. H. SUBEDI

Figure 4. Coronary angiogram with left-anterior oblique (LAO) view. Partially opened left anterior- descending artery (LAD) with interventional glide wire visualized in distal portion of the artery.

ORCID Bishnu H. Subedi

http://orcid.org/0000-0002-0167-7983