ECG pitfall: anterior myocardial infarction in dextrocardia
Bibliographic record
Abstract
A 74-year-old female was admitted to our chest pain unit with a troponin-positive acute coronary syndrome. The standard 12-lead electrocardiogram showed typical features of dextrocardia including atrial and ventricular inversion characterized by a reversal of polarity in leads I and aVL, QS and rS patterns in the precordial leads with progressive decrease in S-wave amplitude from the right to left praecordium (Panel A). No significant ST-segment elevation could be discerned. Reversed lead positioning unmasked ST-segment elevation in the right-sided precordial leads V3R–V5R (Panel B). Coronary angiography revealed subtotal occlusion of the distal left anterior descending coronary artery (Panel C). Cardiac magnetic resonance imaging performed after successful percutaneous coronary intervention showed a left ventricular apical aneurysm associated with thrombus formation and moderately reduced left ventricular systolic function (Panel D). Right-sided precordial lead recording (V3R–V6R) may not only detect right ventricular involvement complicating inferior myocardial infarction but also unmask ST-segment elevation myocardial infarction in rare cases of dextrocardia where standard lead positioning is inconclusive.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".