An 18-year-old student is seen in the respirology clinic because of exacerbation of chronic chest disease due to primary ciliary dyskinesia. CT scans had shown diffuse bronchiectases in both lungs and pansinusitis:

• Negative P wave in I, right axis deviation, rS pattern in the chest leads with decreasing voltage from V3 to V6. compatible with dextrocardia with situs inversus.

Comment: In 1933 Kartagener described a syndrome that took his name, characterized by situs inversus, chronic sinusitis and bronchiectasis. It has been recognized that patients with Kartagener syndrome have primary ciliary dyskinesis that causes impaired mucociliary clearance and sinopulmonary infections. This patient presents the triad of Kartagener syndrome. For proper interpretation of the ECG in dextrocardia, the right precordial leads must be recorded: see ECG 2.

For proper interpretation of the ECG in dextrocardia the right precordial leads have been recorded. The ECG now shows sinus rhythm with no abnormalities: