Electrocardiographic findings in right ventricular hypertrophy

Electrocardiographic findings in right ventricular hypertrophy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Overview

The general electrocardiographic findings of right ventricular hypertrophy include right axis deviation, an R/S ratio > 1 in V1, and the presence of P pulmonale.

Summary of EKG Criteria for RVH

1. Right axis deviation of +90 degrees or more
2. The R wave in V1 is 7 mm or more in height
3. RV1 + SV5 or SV6 = 10 mm or more
4. R/S ratio in V1 = 1.0 or more
5. S/R ratio in V6 = 1.0 or more
6. Late intrinsicoid deflection in V1 (0.035+)
7. Incomplete RBBB pattern
8. ST T strain pattern in 2,3,aVF
9. P pulmonale or P congenitale
10. S1 S2 S3 pattern in children

Differential Diagnosis of R>S in V1

1. RVH
2. Posterior MI
3. WPW
4. HCM (septal hypertrophy)
5. Kulbertus' block (septal fascicular block)
6. Duchennes Muscular Dystrophy
7. Normal variant
8. V4r may be a more useful and reliable than lead V1 in that it often reveals an r>s while v1 remains normal
9. An incomplete right bundle branch block in the right precordial chest leads may signal the development of RVH
10. In the limb leads right axis deviation develops and at times prominent Q waves simulating an IMI appear in leads 2,3, and aVF.
11. In children an S1 S2 S3 pattern (i.e. an S wave deeper than R in all 3 standard leads) is a reliable index of RVH
12. RV strain can be seen in leads V1 and V2 but also in leads 2,3, aVF

Electrocardiographic Examples of RVH

• 

  Right ventricular hypertrophy

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  Right ventricular hypertrohpy, the R wave > the S wave in V1