Nursing Care of Patient with Dextrocardia

Revathy

Emergency Ward Nursing Incharge, Kauvery Heartcity, Trichy, India

Abstract:

21 years old patient came with the complaints of right sided chest pain at 11: 30a.m. Initially went to outside hospital and was referred here for further management. Situs inversus, Dextrocardia since birth, Hypoplastic left ventricle with moderate LV dysfunction, complete AV canal defect, unbalanced with severe systemic atrioventricular regurgitation present. In view of above findings, patient was advised admission for further evaluation. He was started with IV diuretics, inotropes and PED inhibitor.

Introduction:

Dextrocardia is a rare birth defect that causes the heart to be positioned on the right side of the chest, instead of the left. Dextrocardia with situs inversus, commonly known as mirror-image dextrocardia, is a rare congenital malposition of the heart. Incidence is estimated to be around 1 in 8000 to 25,000 live births.

Background:

Mr.Kabilan, a 21-year-old, situs inversus, dextrocardia since birth, S/P Fenestrated Fontan (2013), S/P Fenestration closure (2016), Hypoplastic left ventricle with moderate LV dysfunction, complete AV canal defect, came with complaints of right sided chest pain since 11:30a.m. On examination patient was conscious, oriented, BP and HR were low. ECG showed CHB, RBBB and Echo revealed hypoplastic left ventricle, moderate LV dysfunction, complete AV canal defect, unbalanced with severe systemic atrioventricular regurgitation. In view of above findings, patient was advised admission for further evaluation. He was started with IV diuretics, inotropes and PED inhibitor. Pediatric cardiologist opinion was obtained and his orders were carried out. Nephrologist opinion was obtained in view of elevated renal parameters, and his orders were carried out. Hyperkalemia correction was done. USG abdomen showed left isomerism, heterotaxy syndrome, mild hepatomegaly, moderate ascites, normal in size and echogenicity of both kidneys. Patient was treated with anticoagulants, diuretics, nephro protective drugs, antibiotics, thyroid drugs, PPI and other supportive measures. Patient condition improved and was discharged in a sTable state.  S/P Transesophageal echocardiography +Glenn pressure recording on 09/07/2023 well flowing Glenn and Fontan circuits. Confluent good sized branch PAs. Left arch no coarctation.   S/P Fenestrated Fontan (2013),S/P Fenestrated closure(2016)

ECG:

ECHO:

Situs inversus – Dextrocardia, Hypoplastic left ventricle, moderate LV dysfunction [EF 35%], complete AV canal defect, unbalanced with severe systemic Atrio Ventricular regurgitation.

Past Medical History:

  • Metoprolol XL 50mg BD
  • Lasilactone 1Tab BD
  • Envas 5mg BD
  • Aspirin 75mg OD
  • Warfarin 3mg OD
  • Pan D 40mg OD
  • Thyronorm 12.5mg OD

Immediate Care:

  • ECG was taken and diagnosed CHB and RBBB
  • As per doctor’s order, medication was given and recorded.
  • Vital signs assessed and found painscore:2/10, BP:90/60mmHg, HR:104/min, SPO2:96% in RA
  • Both brachial IV lines inserted
  • Duty doctor initial assessment was done explain high risk, poor prognosis and later discussed the further treatment with primary consultant.
  • Duty doctor explained the condition to attenders.
  • Lasix – 40mg given and Inj. Noradrenaline support.
  • Provided psychological support and requested for pediatrician opinion.
  • Patient shifted to CCU for further medical management.

Diagnosis:

  1. Complex Congenital Heart Disease,
  2. Situs inversus, Dextrocardia, Hypoplastic left ventricle complete AV canal defect
  3. Unbalanced with severe systemic Atrioventricular Regurgitation
  4. Moderate LV dysfunction
  5. Complete heart block related to hyperkalemia
  6. Congestive Heart Failure, Acute kidney Disease
  7. Hyperkalemia (corrected)

Nursing Management:

  • Nurses monitored the vital sign and continued with IV infusion
  • Nurses skilled in IV infusion (Inj. NORADRENALINE, Inj. LASIX) and blood sampling techniques obtained the samples for blood investigations like CBC, ESR, sodium, potassium, RFT, Chest X-RAY, LFT, using sterile technique to prevent thrombophlebitis.
  • Doctors explained the patient condition to the attenders. Nurses obtained consent for the clinical procedures after proper counselling and shifted to CCU.
  • After shifting to CCU, pediatric cardiologist opinion was obtained and his orders were carried out, IV diuretics, Inotropes and PED inhibitors given.
  • Nurses used AIDET technique (Acknowledge, Introduce, Duration, Explanation and Thank you) while communicating with patient and attenders to gain their confidence and improve the satisfaction level of the patients.
  • Recommendation & plan: Don’t skip medicine and review after two weeks
  • Patient stabilized and shifted to ward on 18.05.2025, drug orders followed as per doctor’s advised
  • Patient discharged on 16.05.2025.

Discharged advised

  • Diet advice (1500 Kcal low fat and no vitamin K diet)
  • Medication adherence
  • Daily activity advice
  • Review after one weeks

Outcome:

On discharge patient was hemodynamically stable.

Conclusion:

Dexocardia being a rare condition, this study emphasizes the importance of early detection and tailored diagnostic approaches for accurate management.

References:

  1. van der Linde D, Konings E, Slager M, Witsenburg M, Helbing W, Takkenberg J, et al. Birth prevalence of congenital heart disease worldwide. J Am Coll Cardiol. 2011; 58: 2241-7.
  2. Bohun CM, Potts JE, Casey BM, Sandor GG. A population-based study of cardiac malformations and outcomes associated with dextrocardia. Am J Cardiol. 2007; 100(2): 305-9
  3. Maldjian PD, Saric M. Approach to dextrocardia in adults: review. AJR Am J Roentgenol. 2007; 188(6 Suppl): S39-49.
  4. Sehgal IS, Dhooria S, Bal A, Agarwal R. Allergic bronchopulmonary aspergillosis in an adult with Kartagener syndrome. BMJ Case Rep. 2015; 2015: bcr2015211493.
  5. Hoffman JL, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002; 39: 1890-900

Nightingale Journals

Kauvery Hospital
Find Doctor
Book Appointment