EKG and dextrocardia

[lightbearer06]

So, I had a patient with dextrocardia a few days ago that was being evaluated for chest pain. Once the patient told us that she had dextrocardia, we switched the precordial leads but it was a toss up as to whether or not to switch the limb leads. My thought was that you should switch them as the vectors would be wrong if the electrical impulse was moving in the opposite direction of normal. Any thoughts?

[rev ronin]

My recovering EKG-tech fellow PA student can't remember either. She is positive you change the chest wall leads, but she can't remember about the limb leads. I checked UpToDate, but I didn't see anything useful there, either.

[Neup]

Ok, since nobody answered for a few days, I'll throw my two cents in. Since Dextrocardia is a mirror image of the heart, I would think that you would need to reverse the limb leads as well. I don't think it would make a difference in how the precordials are displayed, but the limb leads and augmented leads would be wrong. Well, I, II, AvR and AvL anyway. III and AvF wouldn't change unless the top and bottom were switched. My guess would be that the R wave progression should be identical to normal placement for patients with the left heart placement. Actually, I would think all aspects of ECG assessment would be the same once the leads were reversed to reflect the condition. I haven't been able to examine a patient w/ dextrocardia. That would be a very cool opportunity.

[aussiedeano]

Yes, ECG (limb & chest)/defib pads must be put in opposite order...