Right Ventricular Hypertrophy

Created by team@ekgdx.com on Jan. 22, 2023

Let’s talk about right ventricular hypertrophy (RVH).

RVH is an abnormal increase of the right ventricular mass in response to chronic pressure overload, most commonly due to tricuspid valve disease, pulmonary hypertension and severe lung disease. 

There are several electrocardiographic changes that may suggest the presence of RVH:

  • Right axis deviation >90°.
  • R in V1 >6 mm.
  • R in V1 + S in V5/V6 >10.5 mm.
  • R/S ratio in V1 >1.
  • rSR' in V1 with R' >10 mm.
  • ST-T wave abnormalities in the right precordial leads.  
  • R/S in V6 <1.

NOTE: Several criteria are needed for accuracy.

NOTE: Electrocardiographic signs of right atrial enlargement are common.

NOTE: EKG has poor diagnostic sensitivity for chamber enlargement, therefore an echocardiogram is necessary. 

 

RVH pattern in V1 - EKGDX

Note the all R wave in V1 with right ventricular strain pattern (ST depression and T wave inversion in the right precordial leads). 

 

Basic anatomical illustration of RVH. 

 

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References

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Thanks for joining us. 

Dr. Roig

Right Ventricular Hypertrophy