Prehospital Diagnosis of Acute ST-Elevation Myocardial Infarction in a Patient with Situs Inversus Totalis

We report a case of a 50-year-old male who presented to emergency medical services (EMS) with acute chest pain, pallor, and diaphoresis. A prehospital diagnosis of ST-elevation myocardial infarction (STEMI) was made following electrocardiogram (ECG) lead reversal by the paramedics secondary to a reported history of situs inversus totalis, a congenital condition with complete reversal or mirroring of the thoraco-abdominal visceral organs. Paramedics initiated a STEMI alert to the emergency department (ED) from the scene, and the patient underwent emergent cardiac catheterization following transport to the hospital. A stent was placed in the left coronary artery, and the patient's symptoms resolved. He was discharged on hospital day three with no complications. This case highlights the need for prehospital clinicians to recognize and adapt when encountering rare conditions like dextrocardia and situs inversus.