What is the medical term for a heart that is oriented to the right instead of the left?

Dextrocardia: Medical Term for Heart Orientation to the Right

Dextrocardia is the medical term for a heart that is oriented to the right side of the chest instead of the normal left-sided position. 1 This condition represents an abnormal cardiac position that can occur with various anatomical arrangements.

Types of Dextrocardia

Dextrocardia can present in different forms based on the relationship between the heart and other organs:

1. Dextrocardia with situs solitus:

   • The heart points to the right while other organs maintain normal positioning
   • Also called "dextroversion" 2
   • Associated with congenital heart defects in 95% of cases 2
   • The apex of the heart is in the right side of the chest (dextrocardia) in approximately 20% of patients with congenitally corrected transposition of the great arteries (CCTGA) 1

2. Dextrocardia with situs inversus:

   • Complete mirror-image arrangement of organs
   • Relationships between cardiac chambers and neighboring structures are preserved 2
   • Shows the classical "mirror image" appearance

3. Dextrocardia with situs ambiguus:

   • Indeterminate organ arrangement
   • Often associated with complex congenital heart disease

Diagnostic Features

Imaging Findings

• Chest X-ray: The heart appears on the right side of the chest
  • In dextrocardia with situs solitus, if the chest x-ray reveals the gastric bubble on the left (abdominal situs solitus) and the apex of the heart on the right, congenitally corrected transposition of the great arteries (CCTGA) should be suspected 1
  • The vascular pedicle often looks abnormal, appearing narrow and straight
  • The ascending aorta may not be visible on the right

Electrocardiographic Changes

• Electrocardiogram (ECG) changes may include:
  • Inverted P waves in lead I
  • Reversed R wave progression in precordial leads
  • Altered QRS axis
  • Need for modified electrode placement to avoid false-positive results for ischemia 3

Clinical Implications

Associated Conditions

• Dextrocardia is frequently associated with other cardiac abnormalities:
  • Congenitally corrected transposition of the great arteries (CCTGA) 1
  • Atrial septal defects 3
  • Ventricular septal defects
  • Pulmonary stenosis
  • Tricuspid valve abnormalities

Management Considerations

• Requires special attention during:
  • Cardiac imaging (modified views needed for echocardiography)
  • ECG interpretation (modified electrode placement) 3
  • Central line placement (must be adjusted for anatomic variations) 3
  • Cardiac surgery (modified surgical approach) 4

Respiratory Associations

• Dextrocardia has been associated with respiratory complications in approximately 25% of patients due to primary ciliary dyskinesia 3

Clinical Pitfalls and Caveats

1. Diagnostic challenges:

   • The diagnosis is often missed because of failure to recognize the abnormal position of the ventricles and associated AV valves 1
   • In some cases, the diagnosis is not made until adulthood

2. ECG interpretation:

   • Incorrect electrode placement can lead to misdiagnosis
   • Q waves in inferior leads (III and AVF) may be misinterpreted as inferior infarction 1

3. Surgical considerations:

   • Cardiac surgery requires modification of standard approaches
   • The surgeon may need to stand on the opposite side of the operating table 4

Dextrocardia should always be thoroughly evaluated to determine the specific situs type and identify any associated cardiac anomalies, as these significantly impact clinical management and outcomes.