Dextrocardia with anterior myocardial infarction: images in cardiology

A 56-year-old female smoker presented to hospital with the sudden onset of chest tightness and dyspnoea, lasting for 4 hours. Clinical and radiological examination revealed dextrocardia and situs inversus. The admission ECG, performed with the electrodes in the conventional position, showed features of dextrocardia (rS complexes and poor QRS amplitude progression from lead V1 to V6, the tall R wave in lead aVR, and P wave and QRS axes directed at +120°) and widespread changes suggestive of myocardial ischaemia/injury (ST segment elevation of 1–2 mm in aVR, ST segment depression inferiorly, and Q waves in aVR, aVL, V1 and V2) (Fig. 1)