Examine this patient's precordium.

Listen to this patient's heart.



· Asymptomatic.

· Obtain history of cough with purulent expectoration (bronchiectasis) and sinusitis.


· Apex beat is absent on the left side and present on the right.

· Heart sounds are better heard on the right side of the chest.

· Ascertain whether the liver dullness is present on the right or left side.

· Examine the chest for bronchiectasis.

Proceed as follows:

Tell the examiner that you would like to perform the following checks:

· Obtain a CXR (look for right-sided gastric bubble).

· Obtain an ECG (inversion of all complexes in lead 1).

Note. Dextrocardia without evidence of situs inversus is usually associated with cardiac malformation. It

may occur with cardiac malformation in Tumer's syndrome


This patient has dextrocardia (lesion) of congenital aetiology.


What is Kartagener's syndrome?

A type of immotile cilia syndrome in which there is dextrocardia or situs inversus, bronchiectasis and

dysplasia of the frontal sinuses (Beitr Kiln Tuberk 1933; 83: 489; N Engl J Med 1953; 248: 730).

Which other abnormality has been associated with dextrocardia?

Asplenia (blood smear may show Heinz bodies, Howell-Jolly bodies) (Br Heart J 1975; 37: 840).

What do you understand by the term 'situs inversus'?

Right-sided cardiac apex, right stomach, right-sided descending aorta. The right atrium is on the left. The

left lung has three lobes and the right lung has two.

What do you understand by the term 'dextroversion'?

Right-sided cardiac apex, left-sided stomach and left-sided descending aorta.

What do you understand by the term 'levoversion'?

Left-sided apex, right-sided stomach and right descending aorta.

M. Kartagener (b. 1897), a Swiss physician, described this condition in 1933.