Right ventricular hypertrophy

Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle.

Blood travels through the right ventricle to the lungs. If conditions occur which decrease pulmonary circulation, meaning blood does not flow well from the heart to the lungs, extra stress can be placed on the right ventricle. This can lead to right ventricular hypertrophy.

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

Differential Diagnosis of Causes of Right Ventricular Hypertrophy

 * Atrial septal defect
 * Cardiac fibrosis
 * Chronic Obstructive Pulmonary Disease (COPD)
 * Cor pulmonale
 * Eisenmenger's Syndrome
 * High altitude
 * Left ventricular hypertrophy or dilation
 * Mitral stenosis
 * Pickwickian Syndrome
 * Pulmonic regurgitation
 * Pulmonic stenosis
 * Tetralogy of Fallot
 * Transposition of the Great Vessels
 * Tricuspid regurgitation
 * Ventricular septal defect