This 38-year-old woman was admitted to the cardiac ward in congestive heart failure. She has been known to have a congenital cardiac abnormality since her teens, but had enjoyed good health until 2 years ago when she developed a Ewing sarcoma of the cauda equina, that was treated with resection and subsequent radiation and chemotherapy. During the past year, she has experienced fatigue and dyspnea on exertion:

• P wave positive in aVR, negative in leads I and aVL
• QR in lead I, rS pattern in the chest leads with decreasing voltage from V1 to V6
• Compatible with dextrocardia with situs inversus

The echocardiogram showed dextrocardia. There was severe global LV hypokinesis (LVEF <25%) and moderate RV hypokinesis. Investigations failed to show evidence of valvular abnormalities or coronary artery disease. It was concluded that the cardiac dysfunction was likely secondary to chemotherapy.