Dextrocardia - Treatment, Symptoms, Diagnosis, Causes, Pictures
What is Dextrocardia?
Dextrocardia is a rare condition characterized by the abnormal positioning of the heart. The heart in Dextrocardia is rather located on the right side instead of its usual position on the left side.
The heart is a vital muscular organ of the body that supplies blood to the entire body through its pumping action via the cardiovascular system. The size is about the fist of the hand and is situated slightly to the left and behind the breastbone. The heart is divided into four chambers where each chamber has their own function. The right atrium is supplied with blood by the veins which it pumps to the right ventricle where the right ventricle in return pumps oxygenated blood to the lungs. The left atrium on the other hand is being supplied with oxygen rich blood from the lungs and which it pumps towards the left ventricle. The strongest chamber among the four chambers of the heart is the left ventricle which acts by pumping oxygen rich blood to the entire body and creates blood pressure from its forceful contractions.
The normal position of the heart is in the mediastinum or the center of the thoracic cavity which contains the other structures of the body. The largest part of the heart is slightly placed on the left side of the thorax in the normal heart position as opposed to Dextrocardia.
The signs and symptoms of Dextrocardia depend on the type of Dextrocardia and if the condition is associated with other medical problems that resulted from the abnormal positioning of the heart. A patient may have Dextrocardia but may not have a problem with the heart while some may have both the abnormality and medical problems related to the unusual position of the heart.
Dextrocardia is generally divided into two main types:
Isolated dextrocardia or also known as Dextrocardia of embryonic arrest is a rare condition in which the heart is abnormally placed on the far right of the thorax instead of its normal position of slightly to the left. The heart is simply positioned to the far right of the thorax and is often associated with abnormalities and defects of the heart.
Dextrocardia with situs inversus
Dextrocardia with situs inversus is the abnormal placement of the heart to the right side of the thorax and is the mirror image of the structure of the heart situated on the left side of the thorax. It is a rare condition that is often associated with other organs of the abdomen being arranged in a mirror image from their usual position. When dextrocardia situs inversus is associated with the mirror image arrangement of other abdominal organs, it is then termed as dextrocardia situs inversus totalis.
An individual affected with either type of dextrocardia may still have a healthy heart and the condition may remain asymptomatic except for dextrocardia associated with other medical problems. Dextrocardia situs inversus on the other hand may have the patient at risk for numerous disorders due to the mirror image arrangement of various organs which can have an effect in their normal function.
If Dextrocardia is associated with other medical problems and causes problems to the heart, the symptoms may include the following:
- Difficulty in breathing
- Rapid breathing
- Rapid pulse rate
- Failure to thrive among children
- Bluish discoloration of the skin
- Yellowish discoloration of the skin and the eyes or a condition known as jaundice
- Pale appearance of the skin
- Weakness and fatigue
A condition called "Kartagener syndrome" may also be seen in some people with dextrocardia. The syndrome involves the cilia of the mucus membrane characterized by an abnormality in the movement where it is moving rather on a wrong direction or may not be moving at all. The dysfunction of the cilia can lead to repeated lung and sinus infection which can be seen and is among the symptoms of the patient with Dextrocardia.
Heterotaxy is a very serious condition characterized by the unusual placement of various organs of the body and the spleen that may be completely missing. Babies affected with Dextrocardia may be affected with Heterotaxy where their spleen may be completely missing resulting to frequent infections throughout the body.
The exact etiology of Dextrocardia remains unknown and the condition is believed to be an error in the anatomical structure during the embryonic stage or while the fetus is developing in the womb.
Structural defects in the lungs, abdomen and other organs in the thoracic cavity is also believed to influence the development of the heart on the right side of the thorax instead on the left side of the thorax which is the normal position. Heterotaxy syndrome which involves multiple organs is also deemed to influence the unusual positioning of the heart.
Both types of Dextrocardia can be medically diagnosed through electrocardiogram or ultrasound of the heart.
Electrocardiogram leads are usually placed in the reverse position in patient with Dextrocardia. The ECG would reveal an extreme deviation in the axis in people with Dextrocardia.
Imaging tests can also help in the diagnosis of Dextrocardia such as:
- Magnetic resonance imaging
- Computed tomography scan
- Plain film X-rays
The imaging tests can reveal the signs of Dextrocardia wherein the heart has an enlargement. Abdominal structures may also be seen with displacements and abnormalities in cases of Dextrocardia situs inversus. Plain film X-rays can reveal problems with regard to the formation of the lungs and the chest.
Dextrocardia not associated with heart problems and abdominal defects may not need treatment. Treatment is generally indicated for Dextrocardia that results or associated with heart problems and dysfunction of other abdominal organs in relation to the displacement or the mirror arrangement.
Surgery is necessary is there is any sign of an obstruction in any organ or part of the body which may be a potential threat to the life of the patient. A septal defect for example, which is associated with Dextrocardia among babies, is necessary for pacemaker placement to facilitate the normal functioning of the heart.
Infections may be prevented and treated with antibiotic medications while long-term antibiotic treatment is indicated for respiratory illness which is a frequent occurrence in people with Dextrocardia manifesting Kartagener syndrome and for babies with Heterotaxy.
Babies born with simple Dextrocardia and without any related heart problem and other medical conditions can live a normal life regardless of the abnormal positioning of their heart. The prognosis for children with Dextrocardia associated with other defects in the heart and other organs of the body depends on the severity and the complication of the condition. A negative prognosis is at a high rate for infants with Dextrocardia associated with Heterotaxy or the complete absence of the spleen. Mortality is usually linked with severe infection arising from the absence of spleen which helps with the immune system.