Ingenuity of precordial leads in diagnosing a patient with dextroversion of the heart complicated by Takotsubo syndrome: A case report.

ABSTRACT

A 71-year-old male with history of a right lung lobectomy for cancer of the right lung complained of resting chest pain. Through the typical echocardiographic findings, takotsubo syndrome was suspected; however, because of dextroversion of the heart, the standard 12­lead electrocardiogram did not show the typical findings of takotsubo syndrome. Based on the finding of the chest-X-ray, in order to adjust for his dextroversion of the heart, the electrodes were then placed on the right side of his chest as modified right-sided precordial leads, in which leads V1-2 were equivalent to basal portion and V5-6 to the apex of the dextroversion of his heart. Negative T waves in the apical leads (V5-6) as a typical finding of takotsubo syndrome were clearly seen. Based on coronary angiogram and left ventriculogram, takotsubo syndrome was definitively diagnosed. Learning objectives: The proper modification of the precordial leads with consideration of the heart position can provide a valuable finding and may be very useful in diagnosing patients with cardiac malposition complicated by cardiac diseases in which identification of impaired site is important.