A Rare Case Study of Dextrocardia with Myocardial Infarction and Cerebrovascular accident in Situs Inversus Totalis

Situs inversus totalis (SIT) is a rare congenital condition, characterized by complete mirror-image transposition of the thoracic and abdominal organs. Although individual reports of myocardial infarction (MI) or cerebrovascular accidents in patients with SIT exist, the simultaneous occurrence of both is extremely rare and poses unique diagnostic and therapeutic challenges. We report the case of a 55-year-old female presenting with right-sided chest pain and later developing neurological deficits. Initial evaluation revealed dextrocardia and SIT on chest radiograph and abdominal ultrasound. Electrocardiogram (ECG) showed ST-segment elevation in leads V1-V4, suggestive of anterior wall MI. The diagnosis was complicated due to reversed anatomical orientation. On day 3, the patient developed left-sided weakness and computed tomography of the brain confirmed an acute infarct in the right parietal lobe. Echocardiography revealed left ventricular apical clot with reduced ejection fraction. A coronary angiogram showed double-vessel disease involving the left anterior descending artery and ramus arteries and percutaneous coronary intervention was performed. This case highlights the clinical complexity and diagnostic uncertainty in managing cardiovascular and neurological events in patients with SIT. To our knowledge, this is one of the first reported cases of concomitant MI and stroke in a patient with SIT.