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Comment & Response
January 31, 2022

Digging Deeper for the Differential Diagnosis of Negative P Waves in Lead I—Reply

Author Affiliations
  • 1Department of Cardiology of the Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
  • 2The Cardiovascular Institute of the First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
JAMA Intern Med. 2022;182(3):358-359. doi:10.1001/jamainternmed.2021.8144

In Reply We appreciate the interest expressed by Drs Zhao and Wang in our recent case report.1 As we discussed, dextroposition (when extracardiac factors displace the heart into the right hemithorax) is a consideration in the differential diagnosis of mirror-image dextrocardia. The comments of Zhao and Wang further highlight that the atypical changes seen in electrocardiogram (ECG) manifestations of dextrocardia should raise suspicion for lead misplacement, as well as for conditions that can exert a mass effect on the heart, eg, a left-sided pneumothorax,2 a hiatal hernia3 or a previous right-sided pneumonectomy.4

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