Electrocardiographic findings in right ventricular hypertrophy


 * Associate Editor-In-Chief:

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