• Images in cardiology

A 21-year-old patient presented to the emergency department with symptoms of shortness of breath and leg oedema that had worsened in the previous six months. An ECG showed atrial fibrillation and a reverse progression of the R wave in the anterior leads, suggesting a diagnosis of dextrocardia (panel A). A chest radiograph revealed enlargement of the cardiac area, and magnetic resonance imaging (MRI) depicted a giant aneurysm (16.0 cm) of the left atrium with severe mitral and tricuspid regurgitation (panel B and video 1; to view video footage visit the Heart website—http://www.heartjnl.com/supplemental). The giant atrium pushed the heart into the right side of the thorax, changing the electrical axis of the heart and altering the ECG. During surgery, the patient was found to have a congenital cleft of the mitral valve, resulting in the unusual enlargement of the left atrium. After surgery, the previous ECG changes disappeared with return of a normal progression of the R wave (panel C). A follow-up MRI showed the heart had returned to its normal left-sided position with a reduction in size of the left atrium (panel D and video 2).

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To view video footage visit the Heart website—http://heart.bmj.com/supplemental