• Michael J Yoo, Rachel E Bridwell, and Joshua J Oliver.
• Department of Emergency Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234, United States of America.
• Am J Emerg Med. 2021 Apr 1; 42: 262.e1-262.e2.

AbstractSitus inversus with dextrocardia is both a clinical and diagnostic challenge for emergency physicians to properly identify acute coronary syndrome. While dextrocardia itself does not independently increase the risk of coronary artery disease, mirrored symptoms, including right-sided and rightward radiating chest pain in any patient with cardiac risk factors should raise suspicion for acute coronary syndrome. In patients with a reversed cardiac silhouette on a chest radiograph, a reversed electrocardiogram, to include both the precordial and limb leads, is necessary to evaluate for cardiac ischemia in presumed dextrocardia. The authors present a case of a 66-year-old man with dextrocardia who presented with shortness of breath and hypotension. Rapid application of a reversed electrocardiogram resulted in the timely diagnosis of ST-segment elevation myocardial infarction and activation of the cardiac catheterization laboratory resulting in the preservation of this patient's life.Published by Elsevier Inc.

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