Usually the heart points to the left side of the body, as shown above. With dextrocardia, the heart points to the right.
Dextrocardia is a congenital condition that is present at birth. There are two main types of dextrocardia.
Dextrocardia situs inversus
With this type of dextrocardia, the tip of the heart and its four chambers are directed to the right side of the body
Total Situs Dextrocardia
With this type of dextrocardia, the organs of the abdominal cavity and chest, as well as other vessels, such as the liver, stomach, and spleen, are also not in their position. In fact, other organs are in the opposite position or in a mirror image where they should be.
Dextrocardia – what is it? Dextrocardia belongs to the category of congenital diseases, characterized by improper placement of the heart muscle. That is, we can conclude that such a pathology is characterized by right-sided placement of the myocardium, despite the fact that in a healthy person it is in the left side of the chest.
A complicated type of dextrocardia is accompanied by various small or complex pathologies.
Given the characteristics of different types of disease, we can conclude that the congenital form cannot be treated, while the acquired disease is not only possible, but necessary to treat. Very often, the signs of such a disease can be distinguished even at the stage of intrauterine development of the fetus, during ultrasound of the fetus it can be recognized that the child’s heart develops in the right side of the chest, and not in the left.
Important! Often, the right-sided arrangement of the heart can be accompanied by a displacement to the opposite side of other internal organs, and this is a very serious and dangerous pathology.
To date, it has not been possible to clearly identify the causes or risk factors that can trigger the occurrence of such a disease. But there is an assumption that in most cases such an ailment is hereditary, that is, it can develop against the background of a genetic predisposition.
Dextrocardia is a rare congenital anomaly in which most of the heart is located on the right side. People often confuse this anomaly with an acquired disorder such as dextroposition of the heart, when the heart is mechanically shifted to the right due to various diseases (left-sided pneumothorax, tumors of the chest or atelectasis of the right lung).
Dextrocardia: forms, what is dangerous, symptoms, diagnosis, treatment
Heart defects are represented by a large group of abnormalities. Many are not visible for a long period. Symptoms are absent. The patient lives fully, does not represent the presence of a problem.
Further, three scenarios are possible: a sharp actualization of the pathology and the formation of the clinical picture, sudden death, a further asymptomatic course.
One of the variants of the anomaly is represented by the displacement of the muscular organ relative to the normal anatomical position.
Dextrocardia is a mirror arrangement of the heart. It is not yet the second week of intrauterine development that is laid, as a result of ectopy (displacement) of the cardiac tube to the right.
The danger is not the deviation itself, but the attendant complications. According to statistics, people with dextrocardia suffer from other defects in 30% of cases.
They are found almost immediately after birth, since it is impossible to not see the displacement of the organ.
In the absence of a complicated course, treatment of the pathology is not required. Regular outpatient monitoring and routine screening as part of routine examinations are indicated.
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The question of whether to consider dextrocardia a disease has not yet been resolved. More and more doctors are inclined to believe that an uncomplicated process is not considered pathological. How is a violation of the anatomical position formed?
Two types of the indicated state are conditionally distinguished. True, when the anomaly is the result of the influence of perinatal factors and false, it can be acquired and always pathological.
In the first case, the main role is given to the genetic moment, random errors. The heart is laid in the second week of gestation, represents the rudiments of a full-fledged organ.
The formation of other organs occurs in accordance with the new “configuration”.
- Isolated dextrocardia is a changed arrangement of the heart and a normal arrangement of the remaining internal organs.
- Partially combined – the reverse location of the heart and lungs (the left lung has three lobes, and the right two).
- Full – a mirror arrangement of the heart and the same transposition of internal organs.
If a genetic defect is to blame, other defects also develop. Including those not related to cardiac structures.
The false form is the result of gross violations. Their influence occurs already in the second or third trimester.
Cases of organ displacement at an older age are known. The classic option is a lung tumor, usually malignant.
As it grows, it provokes a shift in the muscle heart to the other side, forces it out, and causes tissue compression.
In this situation, doctors talk about dextroposition or false malformation. It’s about the disease, and not about the features of development.
Large neoplasias can cause a significant displacement. Therefore, with auscultation (listening to tones), the heart will be detected on the other side.
The same effect is produced by an inflammatory disease (rare), lung pathology, and fluid accumulation in the chest.
It is unlikely if gross deviations in the cardiovascular or respiratory systems are not defined. The main causes of death are acute organ dysfunctions and asphyxiation (suffocation).
No doctor will give a prognosis. This can happen at any time.
Children with a complicated course of dextrocardia live from a year to 12-18 years, extremely rarely longer. Even competent treatment does not guarantee an increase in the average.
Children with the anomaly under consideration almost without exception have a history of Cartagener syndrome. This is a violation of the functional activity of a particular ciliary (ciliated) epithelium located in the respiratory tract.
With the penetration of foreign particles, tissue agents come in irritation, trying to push out foreign objects. Cough begins.
In children with dextrocardia and Cartagener syndrome, the reflex is greatly weakened. Because bacteria with dust, particles of saliva settle in the lungs, provoke constant inflammatory processes that can become fatal.
Represents the result of circulatory disorders in the pelvic organs. This is a consequence of the insufficient contractility of the myocardium.
The filling of cavernous bodies with blood is weak, therefore, a qualitative erection does not occur. In addition, testicles also suffer from ischemia. Spermatogenesis becomes impossible, hence infertility.
Correction of the heart leads to improved reproductive function, but complete recovery in severe patients cannot be achieved.
Also associated with inadequate trophism (blood supply). This time the digestive tract suffers.
Subjectively, the process manifests itself in abdominal pains of unknown origin and localization, flatulence, constipation, diarrhea. Periods alternate.
It develops as a result of generalized inflammation. The result of a long course of the infectious process, often the same pneumonia.
Immunity weakens, resistance to aggressive environmental factors decreases.
Children with dextrocardia mentally mature later than their peers. No gross defects are observed; full compensation is possible with age. But this is not an axiom.
Since the blood circulation of all tissues is impaired, hypoxia (oxygen starvation) is noted. Bones grow slower, there is a delayed increase in muscle mass. Puberty after 10-11 years does not begin, sexual development is meager.
In the remaining 70% of cases (possibly less, data differ, no unified statistics are presented), the right-sided arrangement of the heart is not accompanied by pronounced deviations in the functional activity of other organs and systems. Everything remains normal.
The exact components of the development of dectrocardia are not known. It is assumed that the genetic factor is of primary importance.
Heredity as an unfavorable moment requires constant screening during pregnancy. If there is at least one person with the specified pathology in the family (conditionally speaking), the risk is 10-15%.
Regular observation during gestation will detect an abnormality. After birth, they carefully watch the baby. In a complicated course, symptoms appear almost immediately or on the second day.
In neonatology, deaths of small patients are known several hours after birth.
The consumption of tobacco products should be excluded at least 2-3 months before conception. Moreover, it is impossible to show weaknesses at the time of bearing the fetus.
In the first trimester, the tissues and cells of the embryo are most sensitive to malnutrition. Resins, nicotine, cadmium compounds cause intoxication, poisoning and a fall in the trophism of the primordia of organs.
Dextralgia is an option, one of many. Lucky or not – depends on the ability of the mother’s body to cleanse the blood of harmful substances.
It affects in an identical way. Ethanol provokes a drop in blood flow. Decreased oxygen supply to the embryo. They completely refuse alcohol. There is nothing useful in such drinks; this is a myth and an advertising move.
We are talking about impurities in the air and the quality of water in the place of residence. A huge role is played by an excess of salts of calcium, magnesium, as well as iodine in liquids and foods.
Climatic conditions are less important. Statistics show that the occurrence of dextrocardia is approximately the same in hot and cold regions. There is no geographic or racial, national conditionality.
The higher the level of ionizing radiation, the greater the risks. The problem lies in the formation of free radicals, the oxidation of cell walls and the formation of spontaneous mutations.
Children in regions with a high level of radiation are more often born with heart and vascular defects, developmental disabilities. Dextrocardia is also possible.
The strain does not really matter. 1 – simple, 2 – genital. They provoke pathological processes relatively rarely.
Epstein-Barr virus or the fifth type is much more dangerous, like Varicella-Zoster (causes chickenpox). Viral agents have high mutagenic activity. Therefore, the treatment of all such conditions begins long before pregnancy. Even at the planning stage of gestation.
It will not be superfluous to pass an analysis for a karyotype and consult a geneticist to exclude the incompatibility of partners-future parents.
Mostly Staphylococcus aureus. It is resistant to antibiotics and drugs in general. The products of his vital activity have a mutagenic potential and are produced continuously.
A complete cure does not occur, but there are good chances to transfer the agent to a latent, depressed state.
Curation is carried out before pregnancy, for several months. During the gestation period, the use of drugs is contraindicated, except for extreme cases.
The abundance in the diet of fried, smoked food is unacceptable. Dishes of a similar cooking method contain carcinogens. These are mainly heat-treated products of vegetable fats.
Do not save even cooking with your own hands. Not to mention the dubious quality of purchased products.
Salt is consumed in an amount of up to 7 g, more – it provokes an excess of fluid in the body, an increase in blood volume, impaired functioning of the heart and kidneys. Consequently, ischemia of the embryo, and in the future fetus.
The diet should be balanced. Protein, a minimum of fats and digestible carbohydrates. It is better to discuss the features of the menu with a specialized specialist.
Antibiotics, hormonal drugs (synthetic substitutes for Progesterone, the same Duphaston which doctors in Russia and countries of the former Union prescribe without regard to the indications and condition of the pregnant woman).
Antiviral and fungicides are no less dangerous. Especially anthelmintic medicines. Psychotropics (antipsychotics, tranquilizers, antidepressants).
If there are grounds for admission, consultation with the attending specialist is indicated. In some cases, a review of therapy is required to ensure a safe course of pregnancy.
Perhaps a coincidence. However, nothing just happens. It is a complex combination of factors that cannot be identified.
Usually full mirror
myocardial dextrocardia does not need additional treatment. If in
the existing clinical picture is dominated by heart defects, it is advisable
immediate surgical intervention.
In childhood, more appropriate
drug therapy, including
systematic administration of diuretics, inotropic agents, ACE inhibitors and,
Of course, immunostimulants. However, such conservative treatment is not at all
eliminates the need for surgery for timely troubleshooting in
area of the peritoneum.
Separately, it is worth highlighting and
antibacterial therapy, which is appropriate, both before surgery and in
postoperative period. However, such treatment should be short.
due to the negative systemic effects of antibiotics on vital organs
and systems. In general, the clinical outcome is very favorable in the case of growing
organism, however, the absence of a spleen makes a young patient susceptible
various pathogenic infections.
do not treat heart dextrocardia in a timely manner, then among the possible complications
It is worth highlighting disability and death. If you stick to your whole life
sparing drug therapy, then without special health problems you can
to live to a very old age. Running this disease is certainly not
Clinical manifestations and possible complications
Dextrocardia, which is accompanied by concomitant anomalies of the internal organs, can be complicated:
- frequent and severe infectious diseases;
- septic shock;
- intestinal blockage;
- congestive heart failure;
- male infertility;
In the absence of timely and adequate treatment, the disease is complicated by the development of the following pathological conditions:
- Septic shock
- Heterotactic syndrome,
- Intestinal malrotation,
- Male infertility
- Chronic heart failure
- Impaired male reproductive function,
- Repeated pneumonia,
The abnormal location of the heart in the absence of concomitant pathologies does not pose a particular health hazard, does not affect the quality and life expectancy. In such cases, patients often learn about their characteristics by chance, during a medical examination for another reason.
One of the most significant risks for a patient with undetected and uncomplicated dextrocardia and organ transposition is a medical error in making a diagnosis. Diagnosis of the most common diseases of internal organs is difficult due to their unusual location and the rarity of such clinical cases.
Difficulties arise when it is necessary to perform abdominal operations, especially when it comes to the need for an operation to transplant asymmetric organs. In most cases, a dystopic arrangement is accompanied by other malformations, including: An abnormal arrangement of the heart can be combined with severe organ pathologies, for example, patients are found two- or three-chamber heart.
The danger of the patient’s condition depends on the type of concomitant pathology and its severity. Some concomitant heart defects appear immediately, in the first hours of life (the so-called “blue” defects), some (“white”) can be detected later, due to the asymptomatic course at an early age. Sometimes the right-sided located heart is combined with other pathologies of the abdominal and pleural cavities.
One of the most common concomitant pathologies is heterotactic syndrome. Patients with heterotactic syndrome often do not have a spleen, in some cases several underdeveloped spleens with significant impairment of functions are found. Half of patients with PCB are diagnosed with Cartagener-Sievert syndrome, which is inextricably linked to the abnormal position of the internal organs. In such patients, pathological disorders of the anatomical structure of the upper respiratory tract, numerous bronchiectasias are revealed.
Cilia on the surface of the mucous membranes, performing the functions of an active filter, may be completely absent. Men with this disease are infertile, since their spermatozoa lack flagella. This pathology is always combined with a complete or partial transposition of internal organs, which indirectly confirms the hypothesis of the hereditary nature of dextrocardia.
A dystopic arrangement of the heart is often found in children with Patau syndrome – trisomy of 13 pairs of chromosomes. This chromosomal disease is accompanied by multiple malformations affecting almost all organ systems; patients with Patau syndrome rarely live to school age. Uncomplicated dextrocardia combined with complete transposition of internal organs usually does not manifest itself in any way and does not bother the patient at all.
- Jaundice staining of the skin and sclera from the moment of birth;
- Difficulty breathing
- Cyanosis or pallor of the skin;
- Heart rhythm disorders.
In older children, in addition to the listed symptoms, the following can be observed:
- Increased susceptibility to infectious diseases of the lungs and upper respiratory tract;
- Fatigue, muscle weakness;
- Lag of physical development.
Usually people who have dextrocardia do not know about their feature, because it does not have pronounced symptoms. But it can manifest itself by a heartbeat in the right side of the center of the chest.
But if such a feature is found in infants who have any pathologies in the work of the heart, then in such cases an urgent specific treatment is necessary. The baby’s heart problem is determined by the following signs:
- the child is exhausted for a long time;
- the baby does not gain weight;
- he has frequent infections of an infectious nature (sinusitis, lung problems, etc.);
- difficulty breathing, shortness of breath;
- the skin is slightly yellow;
- cyanosis in the area of the fingers of the upper and lower extremities.
Internal organs, which are located not in their places, but in opposite parts of the peritoneum, usually function normally. But the fact that they are abnormally located sometimes makes it difficult to make a correct diagnosis. An example of this is pain with an inflamed appendix, which occurs on the left, and not on the right, as in people with a normal arrangement of organs. Such anatomical differences make operations difficult.
An abnormal location of the heart in the fetus is detected by ultrasound. This anomaly is of two types:
- dextrocardia and mesocardia;
Ectopia is the location of the heart outside the chest. In addition, a newborn baby with this feature may have omphalocele. This is an anomaly in which some internal organs appear in the hernial sac outside the abdominal cavity: part of the intestine, liver, and others. If an ultrasound is performed on a woman with a fetus with omphalocele and dextrocardia and such a problem is found, then after the baby is born, he needs to undergo surgery.
There is such a thing as tests for determining dextrocardia of the heart. They include a whole range of studies. To determine the anomaly, you need:
- make an electrocardiogram;
- undergo an ultrasound of the heart;
- undergo computed tomography;
- do an MRI of the heart.
Among the possible diagnostic methods, electrocardiography is primarily prescribed. An electrocardiogram (ECG) for dextrocardia shows the degree of development of pathologies of myocardial function, if there are congenital malformations. At the same time, it seems that the application of electrodes to the chest was incorrect, because all the indicators are shown in mirror image. A chest x-ray shows the true location of the heart.
Although the reversed organs themselves can function normally, their incorrect location often makes it difficult to diagnose other conditions. For example, in someone who has sedentary dextrocardia, appendicitis causes severe pain in the lower left abdomen, and not in the right.
When these anatomical differences occur, they can also make surgery difficult.
Other complications associated with dextrocardia may include:
- bowel disorders, usually due to obstruction due to improper handling (reverse)
- bronchial diseases, such as chronic pneumonia, associated mainly with the loss of cilia (hair protrusions) from mucous tissues
- сердечно-сосудистые заболевания
- heart failure or illness
- infection and sepsis
Reasons and types of dextrocardia
The location of the heart may change due to the fact that during the growth of the embryo, the development of its heart tube in the first trimester of pregnancy is disrupted. She begins to bend not to the left, as it should be, but to the right. This leads to a mechanical displacement of the heart to the right side of the chest cavity.
People with such an inborn pathology can live their whole lives, and never find out that their heart is in a mirror image, because often this does not affect their health. They can get such stunning news quite by accident, having undergone a routine examination or being examined for an illness on an ultrasound machine.
If a person does not have pathologies that can accompany dextrocardia, then he leads a normal lifestyle, because such an anomaly does not shorten life expectancy and does not impair its quality. It is not inherited, therefore people who have a heart located on the right have healthy children, although there is a low probability of a future offspring repeating this feature.
Symptoms occur when:
- there are any other congenital heart defects;
- Dextrocardia is a sign of Kartagener-Sievert syndrome.
Due to the fact that dextrocardia is combined with Cartagen-Sievert syndrome and other anomalies, experts believe that there are three types of dextrocardia:
- The location of the heart is on the right.
- In the opposite side of the norm are not only the heart, but also some internal organs.
- All organs, including the heart, are located in specular reflection.
According to a group of other scientists, a sign of an abnormal arrangement of organs allows us to determine such forms of dextrocardia:
- Uninsulated, in which transpositional placement is characteristic of all internal organs.
- Isolated, in which only unpaired organs (spleen, stomach and liver) have normal placement.
The second form has such subspecies, depending on whether there is an inversion of the atria and ventricles.
For the first time, an abnormal arrangement of the heart on the right was discovered and described by the Italian surgeon-anatomist Jerome Fabrice in 1606, and in 1643 Marco Aurelio Severino described a case of dextrocardia, which was accompanied by a mirrored arrangement of the abdominal organs.
Doctors know that this anomaly in the location of the heart occurs in the third trimester of pregnancy and is observed in one of 8-25 thousand newborns. Genetics claim that dextrocardia is caused by the gene mutation HAND, ACVR2, ZIC3Shh and Pitxz, and is inherited in an autosomal recessive manner. Normally, during fetal development, the fetal heart tube begins to bend to the left, and with dextrocardia, to the right.
Vessels that enter and leave the heart also change their usual location in the mirror direction. Sometimes dextrocardia is accompanied by an abnormal location or displacement of other internal organs (for example, the liver is located on the left and the spleen on the right). There are three main types of dextrocardia:
- I – only the heart is located on the right;
- II – the heart and some internal organs are located on the right;
- III – the heart and all internal organs are abnormally located.
The first type of dextrocardia is called simple, and the other two are specular. In children with dextrocardia, Kartagener syndrome is always observed, in which there are no cilia in the respiratory system (the finest hairs). This condition makes it difficult to filter air from dust, and the child often suffers from colds, sinusitis, bronchitis, and other otolaryngological and pulmonological diseases. Cardiologists have noted the fact that some congenital heart defects are often observed with dextrocardia:
- pulmonary stenosis;
- transposition of the great vessels;
- defect of interventricular septum;
- double ventricular exit;
- endocardial defects.
In children with dextrocardia, abnormal development, functioning and location of many organs of the respiratory and digestive systems can be observed. This anomaly is called heterotaxia. With it, an almost complete absence of the spleen or the presence of several small and not functioning normally spleens can be observed.
- severe heart defects.
Simple dextrocardia, which is not accompanied by congenital malformations of the heart and internal organs, is asymptomatic. As a rule, this anomaly of the location of the heart is detected in infancy or childhood, but there are cases when it is accidentally detected in adulthood during a routine examination or examination for another disease.
Such people may not make any complaints about their state of health, and only more often than others suffer from diseases of the respiratory system. They can give birth to healthy children, but the likelihood of having a baby with dextrocardia in such people or their descendants increases. With the combination of dextrocardia with other abnormalities of the internal organs in the early stages of the disease, the following symptoms may manifest themselves:
- stunting and weight gain;
- tendency to infectious diseases of the respiratory organs;
- severe weakness;
- shortness of breath or rap >”Alt =” ”>
In some cases, dextrocardia, accompanied by violations in the structure and location of internal organs, appears immediately after the birth of the baby. Such children experience jaundice, passivity, pallor and shortness of breath. In the future, the clinical picture of dextrocardia is supplemented by symptoms that are characteristic of disturbances in the functioning of abnormally located organs or heart disease. Their severity depends on the degree of organ damage.
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