A 12-year-old boy attended the Primary Care Pediatrician's office due to general malaise, fever, hypoxia and frequent soft stools.
He was diagnosed with acute gastroenteritis.
In cardiac auscultation, in addition to rhythmic tone without murmurs or anomalies in the second tone, a piece of information was observed that referred attention.
The child was asked about a history of precordial pain, presyncopes, syncopes, exercise-related symptoms, as well as tolerance to exercise suggestive of heart disease and dysrhythmia sensation, without answers.
After performing an electrocardiogram (ECG) and a chest X-ray, and once the pediatrician confirms his suspicion, the patient is a paediatric cardiology specialist to complete the study.
1.
What is the ECG interpretation? And the auscultatory finding that refers to the pediatrician's attention? And the diagnostic suspicion?
It is necessary to check the ECG before reading.
The ECG shows, following systematic reading, an ectopic atrial rhythm coming from the upper part of the left atrium (negative P wave in I, positive in aVF).
However, we observed an anomalous axis (right) of QRS and T-wave (adequately 180o in both), since both QRS complexes and T-waves are negative where usually positive aVL (IVL).
These electrodes can only be misplaced by placing the totality of the electrodes (in the wrong hemithorax) or by the existence of x-ray in the right hemithorax).
The auscultatory finding was the presence of cough in the right hemithorax; also, the chest X-ray showed right heart dexterity, liver located in the left hemiabdomen and gastric bubble in the abdomen.
With the confirmation of situs inus totalis, the child was diagnosed with infantile cardiology to rule out congenital heart disease.
