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Images in cardiovascular medicine. Double-chambered right ventricle and situs inversus with dextrocardia.

We report the case of a 74-year-old woman with a history of complex congenital heart disease consisting of double-chambered right ventricle (DCRV) and situs inversus with dextrocardia. To our knowledge, this is the first reported case with the combination of these 2 congenital abnormalities. The patient was transferred to our hospital after experiencing abdominal discomfort, malaise, and cold sweats for 3 days. Initial examination revealed slightly elevated cardiac troponin T (peaked at 0.56 ng/mL). With her known history of dextrocardia, 12-lead surface electrocardiography (ECG) with both standard precordial leads (Figure 1A) and right-sided precordial leads (Figure 1B) was performed. The standard ECG was notable for inverted P waves in the lateral leads (I and aVL), suggesting rightward atrial electric forces and poor R wave progression. The right-sided precordial lead ECG showed normalized R wave progression. These summations of ECG findings are suggestive of dextrocardia. There were also pseudo-Q waves in the limb leads and T wave inversions in I and aVL, which are also consistent with dextrocardia but less specific than the other findings. In addition, her right-sided ECG showed ST depression and T wave inversion in the anterior leads, which in the …