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Dextrocardia

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  • Pam
    Hi everyone, I have a patient coming in on Thursday who has dextrocardia. I have never scanned a dextrocardia patient before. I work in a clinic where there
    Message 1 of 7 , Apr 30, 2004
      Hi everyone,

      I have a patient coming in on Thursday who has dextrocardia. I have
      never scanned a dextrocardia patient before. I work in a clinic
      where there are no other echo techs but myself. I know that I'll
      have the patient lie on their right side facing me (I am a right-
      handed scanner). Basically all the windows are the same, but just
      opposite right?

      Any tips you can give me would be great!

      Thanks,
      Pam :)
    • Makram Ebeid
      The tips I would give you is that start as your regular and try to find the best window with slowly sliding your hand right ward and if that does not work then
      Message 2 of 7 , May 3, 2004
        The tips I would give you is that start as your regular and try to find
        the best window with slowly sliding your hand right ward and if that
        does not work then try letting him lie on the right side. A lot of times
        what is called Dextrocardia is dextrorotation of the apex and lying on
        the left may be still better It varies from one patient to the other. If
        nothing else works go for subcoastal though that is not always easy with
        the older patients.
        The other tip DO NOT INVERT the images or your hand to make it appear
        correct.


        Makram R. Ebeid, MD, FAAP, FACC, FSCAI
        Director Ped. Cath Lab
        University of Mississippi Medical Center
        2500 N. State St,. Jackson, MS 39216
        Tel (601)984-5250
        Fax (601)984-5283
        E-mail: mebeid@...

        >>> pdawson@... 04/30/04 08:12PM >>>
        Hi everyone,

        I have a patient coming in on Thursday who has dextrocardia. I have
        never scanned a dextrocardia patient before. I work in a clinic
        where there are no other echo techs but myself. I know that I'll
        have the patient lie on their right side facing me (I am a right-
        handed scanner). Basically all the windows are the same, but just
        opposite right?

        Any tips you can give me would be great!

        Thanks,
        Pam :)





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      • Mhibby@AOL.com
        Pam--Dextrocardia is hard for everyone. My advice would be to start subcostally to see if this patient truly is dextrocardia or just dextrapositioned. If the
        Message 3 of 7 , May 3, 2004
          Pam--Dextrocardia is hard for everyone. My advice would be to start subcostally to see if this patient truly is dextrocardia or just dextrapositioned. If the apex of the heart is to the right then it is dextrocardia--sometimes the apex will look right in the middle or mesocardia or shifted over to the right more, but the apex is still to the left so there is just dextropositioning of the heart.

          It can be very confusing and it is hard not to let your hand correct itself so the images appear normal to your eye--keep your transducer orientation the same as you would if you were scanning normally--and keep rotating the scan head clockwise and you go through the different planes. Take your time and take a deep breath--it is hard but you can do it if you have patience with yourself.

          Good luck.
          Barbara Hibdon
        • cdecho0510
          I have imaged several dextrocardia patients. My first suggestion is to make sure you have allotted enough time in your schedule to perform an accurate study.
          Message 4 of 7 , May 3, 2004
            I have imaged several dextrocardia patients. My first suggestion is
            to make sure you have allotted enough time in your schedule to
            perform an accurate study. An accurate anatomical diagnosis is
            key. Remember to look for the limbus fossae ovalis on the septal
            wall of the right atrium. The left atrial can be defined by its
            left atrial appendage which is constricted at its junction with the
            left atrial. The RV of course has the moderator band and a coursely
            trabeculated wall while the LV has the smoother surface.

            I would begin with the patient flat and utilize the subcostal view
            to determine if the patient is a true dextrocardia or a
            dextroposition (shift of the heart to the right of the chest). Once
            this is determined, I would roll the patient to the right. It helps
            to have a bed with a right cut out or door that drops open. I
            usually start with the transducer index marker at 11 o'clock and
            rotate around as needed. When I do the apical views, I feel for the
            point of maximal impulse with my hand then put the transducer on
            it. Dextrocardia are not as easy to image because the heart can be
            rotated and seems to sit a little lower in the chest. You really
            have to be careful to look for associated congenital defects such as
            VSD or pulmonic stenosis, anything is possible. Make sure you do a
            supra sternal notch view to see the direction of the aortic arch and
            try to look at the pulmonary venous connections. I would also do
            alot of subcostal scanning to note the position of the liver. Just
            make sure to take a deep breath and get ready to turn your hand
            opposite the way your hand wants to go.
            Cheryl
          • mlouw44@aol.com
            Hi, I had an interesting case where the 30 s yr old patient had had the right lung removed and his heart had fliped over to the right. I could not find any
            Message 5 of 7 , May 5, 2004
              Hi,
                I had an interesting case where the 30's yr old patient had had the right lung removed and his heart had fliped over to the right.  I could not find any images on the left or apical window in the normal locations.   The patient mentioned that everyone who listens to him does so from his back.  So, I got all my images with the patient laying on his stomach on the right side of his back.  That was a new one for me. 
                Just a FYI information.
              Marylou
            • G M
              Pam: Dextrocardia should provide an education of how much of the exam is hard-wired. A lot of the routine or reflex actions are going to seem backwards, and
              Message 6 of 7 , May 5, 2004
                Pam:

                Dextrocardia should provide an education of how much of the exam is
                "hard-wired." A lot of the routine or reflex actions are going to seem
                backwards, and it would seem the advice offered on the exam by Barbara is
                worth considering.

                Dextrocardia exists in two variants well known to medicine, as well as a
                third lesser known variant.

                When dextrocardia can occur with a normal orientation of abdominal organs
                (liver on the right, spleen on the left) or with reversal of the abdominal
                organs (liver on the left, spleen on the left.) The former is known as
                SITUS SOLITUS, whereas the latter is also known as SITUS INVERSUS, which
                should be easy to GOOGLE. (It was for me.) It should be easy enough to get
                a clue about which side the liver is on. <g> You can at least score some
                points with the cardiologist by identifying this part of the patient's
                condition (although it should already be known.)

                The location of the abdominal organs is important, as there is a higher
                incidence of congenital abnormaliites when the abdominal organs are located
                on the NORMAL SIDE. There are other medical conditions, e.g. Kartagener's
                Syndrome, related to ciliary function, which likely won't relate to your
                exam per se'. The exam is what it is, but be thorough in looking for
                congenital abnormalites--already a tough task with everything being
                reversed.

                Oh, that third variant? It"s Bizarro-cardia. Everything is reversed,
                patients usually sport a Van Dyke beard, and use strange grammar, such as
                "Me is here for echo test." Glowing eyes and a creepy grin are a dead
                give-away.

                Good luck,

                SCOTT

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              • Abello4@cs.com
                Only if its a straingforward dextrocardia. And you should image it as it is. In otherwords dont change the orientation. Anne
                Message 7 of 7 , May 5, 2004
                  Only if its a straingforward dextrocardia. And you should image it as it is. In otherwords dont change the orientation.
                  Anne
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