O. Taoussi^1,, H. Kamri¹, H. Rabii¹, M. Mokhtari¹, Z. Azeddoug¹, FZ. Merzouk¹, G. Benouna¹

Dextrocardia with situs inversus is a rare congenital condition in which thoracoabdominal organs follow a complete mirror orientation. While individuals are often asymptomatic, the management of acute coronary syndrome in this setting poses significant diagnostic and interventional challenges due to reversed anatomical relationships. We report a 60-year-old man with known dextrocardia who presented with acute anterior myocardial infarction. The initial ECG, recorded with standard left-sided precordial leads, failed to show clear ST-segment elevation; however, repositioning the leads to the right hemithorax revealed marked anterior ST elevation. Coronary angiography required systematic technical adaptation, including alternative catheter selection and “mirror-opposite” fluoroscopic projections to visualize the left anterior descending artery correctly. Primary percutaneous coronary intervention was successfully performed using an Amplatz Left 1 catheter for the left coronary artery and an Amplatz Right 1 catheter for the mirrored right coronary ostium. This case underscores the critical need for early recognition of dextrocardia and a structured approach to adapting catheter selection and angiographic views to ensure safe and effective coronary intervention in this challenging anatomical setting.

Dextrocardia, Situs inversus, Acute coronary syndrome, Percutaneous coronary intervention, Coronary angiography, Anatomical variation