Right ventricular hypertrophy

Jump to: navigation, search
Right ventricular hypertrophy
Right Ventricular hypertrophy.svg
Right Ventricular hypertrophy

WikiDoc Resources for Right ventricular hypertrophy

Articles

Most recent articles on Right ventricular hypertrophy

Most cited articles on Right ventricular hypertrophy

Review articles on Right ventricular hypertrophy

Articles on Right ventricular hypertrophy in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Right ventricular hypertrophy

Images of Right ventricular hypertrophy

Photos of Right ventricular hypertrophy

Podcasts & MP3s on Right ventricular hypertrophy

Videos on Right ventricular hypertrophy

Evidence Based Medicine

Cochrane Collaboration on Right ventricular hypertrophy

Bandolier on Right ventricular hypertrophy

TRIP on Right ventricular hypertrophy

Clinical Trials

Ongoing Trials on Right ventricular hypertrophy at Clinical Trials.gov

Trial results on Right ventricular hypertrophy

Clinical Trials on Right ventricular hypertrophy at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Right ventricular hypertrophy

NICE Guidance on Right ventricular hypertrophy

NHS PRODIGY Guidance

FDA on Right ventricular hypertrophy

CDC on Right ventricular hypertrophy

Books

Books on Right ventricular hypertrophy

News

Right ventricular hypertrophy in the news

Be alerted to news on Right ventricular hypertrophy

News trends on Right ventricular hypertrophy

Commentary

Blogs on Right ventricular hypertrophy

Definitions

Definitions of Right ventricular hypertrophy

Patient Resources / Community

Patient resources on Right ventricular hypertrophy

Discussion groups on Right ventricular hypertrophy

Patient Handouts on Right ventricular hypertrophy

Directions to Hospitals Treating Right ventricular hypertrophy

Risk calculators and risk factors for Right ventricular hypertrophy

Healthcare Provider Resources

Symptoms of Right ventricular hypertrophy

Causes & Risk Factors for Right ventricular hypertrophy

Diagnostic studies for Right ventricular hypertrophy

Treatment of Right ventricular hypertrophy

Continuing Medical Education (CME)

CME Programs on Right ventricular hypertrophy

International

Right ventricular hypertrophy en Espanol

Right ventricular hypertrophy en Francais

Business

Right ventricular hypertrophy in the Marketplace

Patents on Right ventricular hypertrophy

Experimental / Informatics

List of terms related to Right ventricular hypertrophy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and Keywords: RVH, RV strain

Overview

Right ventricular hypertrophy refers to thickening of the heart muscle of the right ventricle.

Pathophysiology

Blood travels through the right ventricle to the lungs. If there is increased resistance to flow in the pulmonary circulation, the stress placed on the right ventricle can lead to right ventricular hypertrophy.

Causes of Right Ventricular Hypertrophy

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Atrial septal defect, cardiac fibrosis, coarctation of the aorta, congenital heart disease, cor pulmonale, Eisenmenger's syndrome, hypoplastic left heart syndrome, left ventricular hypertrophy or dilation, mitral stenosis, obstructive sleep apnea, primary pulmonary hypertension, pulmonary embolism, pulmonary hypertension, pulmonic regurgitation, pulmonic stenosis, tetralogy of Fallot, transposition of the great vessels, tricuspid regurgitation, ventricular septal defect
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect No underlying causes
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental Coal worker pneumoconiosis, high altitude
Gastroenterologic Cystic fibrosis
Genetic Congenital heart disease, cystic fibrosis, Eisenmenger's syndrome
Hematologic Pulmonary embolism
Iatrogenic No underlying causes
Infectious Disease Paracoccidioidomycosis
Musculoskeletal/Orthopedic Scoliosis
Neurologic High altitude, obstructive sleep apnea
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic No underlying causes
Ophthalmologic No underlying causes
Overdose/Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Bronchiectasis, chronic obstructive pulmonary disease, Churg-Strauss syndrome, coal worker pneumoconiosis, cor pulmonale, cystic fibrosis, high altitude, interstitial lung disease in children (ChILD), miliary tuberculosis, obesity hypoventilation syndrome, obstructive sleep apnea, paracoccidioidomycosis, Pickwickian syndrome, primary pulmonary hypertension, pulmonary embolism, pulmonary fibrosis, pulmonary hypertension, scoliosis
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy Churg-Strauss syndrome
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Diagnosis

EKG Findings in Right Ventricular Hypertrophy

Right ventricular hypertrophy

Shown below is a tracing from lead V1 which shows right ventricular hypertrohpy, with an R wave > the S wave in V1

E rvh.jpg

Diagnostic Criteria for Right Ventricular Hypertrophy

  • Right axis deviation of +90 degrees or more
  • RV1 = 7 mm or more
  • RV1 + SV5 or SV6 = 10 mm or more
  • R/S ratio in V1 = 1.0 or more
  • S/R ratio in V6 = 1.0 or more
  • Late intrinsicoid deflection in V1 (0.035+)
  • Incomplete RBBB pattern
  • ST T strain pattern in 2,3,aVF
  • P pulmonale or Right atrial enlargement or P congenitale
  • S1 S2 S3 pattern in children
  • Tall R wave in V1 or qR in V1
  • R wave greater than S wave in V1
  • R wave progression reversal
  • Inverted T wave in the anterior precordial leads

Differential Diagnosis of R>S in V1

  • RVH
  • Posterior MI
  • WPW
  • HCM (septal hypertrophy)
  • Kulbertus' block (septal fascicular block)
  • Duchennes Muscular Dystrophy
  • Normal variant
  • V4r may be a more useful and reliable than lead V1 in that it often reveals an r>s while v1 remains normal
  • An incomplete right bundle branch block in the right precordial chest leads may signal the development of RVH
  • In the limb leads right axis deviation develops and at times prominent Q waves simulating an IMI appear in leads 2,3, and aVF.
  • 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
  • RV strain can be seen in leads V1 and V2 but also in leads 2,3, aVF

References

  1. http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch7/s4ch7_32.htm
  2. 2.0 2.1 2.2 2.3 Harrigan RA, Jones K (2002). "ABC of clinical electrocardiography. Conditions affecting the right side of the heart.". BMJ. 324 (7347): 1201–4. PMC 1123164Freely accessible. PMID 12016190. 
  3. Wood WC, Wood JC, Lower RR, Bosher LH, McCue CM (1975). "Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three.". J Pediatr. 87 (2): 217–20. PMID 125322. 
  4. Whayne TF (2013). "Cardiovascular Medicine at High Altitude.". Angiology. PMID 23892441. doi:10.1177/0003319713497086. 
  5. Tartulier M, Boutarin J, Ritz B (1984). "Chronic pulmonary thromboembolism.". G Ital Cardiol. 14 Suppl 1: 13–21. PMID 6534760. 

Linked-in.jpg