INTRODUCTION:

Dextrocardia was first recognized by “Marcoseverino” in 1643 and situs inversus by matthew Bailie over half a century later. ^[1] Dextrocardia is an abnormal congential positioning of heart. Instead of heart forming in fetus on left side, forms on right side. In majority of cases of dextrocardia is associated with cardiac malformations, most of them are cyanotic type.[2] Dextrocardia with situs inversus occurs rarely, with an estimated incidence of 1 in 6,000 – 35,000 live births ^[3] or 1 in 8,0000 from mass adult radiographic screening. ^[4]Here we described a case of dextrocardia with situs inversus- a rare case report.

CASE STUDY:

A 45 years old male admitted to Prathima Institute of Medical Sciences, Karimnagar on 3^rd May 2015. His complaints are giddiness, syncope frequently if he does excessive on exertion, fever, chest pain, cough and respiratory distress. His past history, there was no family history of cardiac diseases or hypertension and diabetes mellitus.

Physical examination: the location of the apex beat at the 5^th intercostals space at mid clavicular line and all other organs were normal. His vital signs included a blood pressure 120/80 mmHg, heart rate 94 beats per minute (bpm), regular, respiratory rate 20 bpm, regular, and his oxygen saturation was 97%. Cardiovascular examination showed heart sounds on right side, and S1, S2 were normal. Skin was warm and dry.

Chest radiograph showed cardiac apex, aortic arch on the right, while the intermediate bronchus was on left side. Electrocardiographic findings were a reverse placement of the precardial leads on the right corrected these abnormalities. Echocardiogram revealed dextrocardia, situs inversus, normal values/chambers, left and right ventricular functions were normal. There is no clot in left atrium/left ventricle and no pericardial effusion. Ultrasound scan of abdomen showed right renal calculus and situs inversus totalis.

Figure 1: Chest radiograph showing cardiac apex, aortic arch and stomach bubble on right side suggestive of situs inversus totalis

Figure 2: ECG showing the chest leads reversed (right- sided chest leads format) positions on a person with dextrocardia

Figure 3: Ultrasongraphy of abdomen showing liver, right kidney on left side and spleen, left kidney on right side suggestive of situs inversus totalis.

MEDICAL MANAGEMENT:

Treatment given to the patients was Tab. Lupefit, once daily; Tab. Restyl 0.5 mg at bed time and Low sodium diet was advised. A permanent pace maker was inserted during the second week of hospitalization. The incision was made 3cm below the left clavicle and cephalic vein was exposed in the deltopectoral groove. The electrode catheter was guided to the right ventricular cavity through the left side superior vena cava. The patient was immediately placed in the lateral position, and the catheter was guided to the apex of the right ventricle using the lateral projection of the angiogram as a reference. After 1 week, the patient recovered and discharged without symptoms. The first pacemaker was implanted in 1958.^[5] The goal of pacemaker therapy is to support the cardiac electrical system in the initiation or condition of impulses, but pacemakers are also employed in the treatment of certain forms of syncope and cardiomyopathy.

NURSING MANAGEMENT:

Advanced nurse clinicians should have a basic understanding of pacemaker function, indications for implantation, and an awareness of potential complications as well as facility with basic troubleshooting. Nursing care is a key factor in achieving positive outcomes and enhancing parental satisfaction. The following nursing interventions are,

· Relieving pain with back rest: A complete bed rest was provided with propped up position. Prescribed medications were administered.

· Hemodynamic monitoring was done continuously.

· Elevation of the head

· Improving respiratory function

· Maintained fluid volume status in order to prevent over loading the heart and lung.

· Promoting adequate tissue perfusion

· Reducing anxiety

· Monitoring and managing potential complications

· Teaching patient self-care.

PREVENTION:

Healthy diet, avoiding smoking (cigarettes) and alcohol are beneficial.

CONCLUSION:

Dextrocardia with situs inversus totalis is a rare condition. Most of patients with these syndromes were detected in infancy but our case was an adult. After pace maker implantation, patient was safe and discharged home in good health.

REFERENCES:

1. Wilhelm A, Holbert MJ. Situs inversus. E-medicine. 2002: 1-2.

2. Veneziani N, Despasquale C, Ferlan G, Mannatrizio G, Veneziani A. Pacemaker implant in dextrocardia with right superior vena and persistence of situs inversus viscerum- case report. Progressin BioMed Res. 1999;307-370.

3. Sandro C, Raffaele DV, Roberto Z. Suspected appendicitis in situs inversus tortalis. An indication for a laparoscopic approach. Surgical laparoscopy and endoscopy. 1998; 8: 393-4.

4. Garson A, Bricker JT, McNamara DG. The science and practice of paediatric cardiology.1990; 1282.

5. Adeye Kun AA, Onunu AN, Mazeli FO. Dextorcardia with situs inversus: A case report. WAJM.2003; 22: 358-360.

Received on 17.07.2015 Modified on 27.07.2015

Int. J. Nur. Edu. and Research 3(4): Oct.-Dec., 2015; Page 371-372

DOI: 10.5958/2454-2660.2015.00025.3