eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2025-12-11 13 12 84 87 10.12691/ajmcr-13-12-1 AJMCR202513121 article O. Taoussi taoussi75@gmail.com 1 H. Kamri 1 H. Rabii 1 M. Mokhtari 1 Z. Azeddoug 1 FZ. Merzouk 1 G. Benouna 1 Department of Cardiology, Cheikh Khalifa International University Hospital, Mohammed VI Foundation of Health and Sciences, Casablanca, Morocco 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 ˇ°mirror-oppositeˇ± 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. https://pubs.sciepub.com/ajmcr/13/12/1/ajmcr-13-12-1.pdf Dextrocardia Situs inversus Acute coronary syndrome Percutaneous coronary intervention Coronary angiography Anatomical variation