ecg_rvh

right ventricular hypertrophy (RVH)

congenital heart disease (CHD) causing RV outflow tract obstruction such as:
- pulmonary atresia
- pulmonic stenosis
- Fallot's tetralogy
pulmonary disease such as:
- recurrent or massive pulmonary embolism (PE)
- pulmonary hypertension
- chronic obstructive pulmonary disease (COPD) and Pickwickian syndrome
cardiac disease such as:
- mitral stenosis
- myocardial diseases causing high LV end-diastolic pressures

exclude Right Bundle Branch Block (RBBB) and WPW - if present cannot make ECG Dx of RVH
normally the electrical forces of the LV dominate the ECG, thus for RVH to become evident on an ECG, the RV must usually be at least double its normal mass to overcome the LV electrical forces
thus the ECG is not sensitive for RVH but ECG changes can be relatively specific for RVH
early ECG changes include:
- rSr' or qR pattern in V1
QRS may widen as with left ventricular hypertrophy (LVH) and this may manifest as a complete or incomplete Right Bundle Branch Block (RBBB)
J point depression and ST depression in inferior and right precordial leads (eg. V1)

R/S ratio in V5 or V6 < 1
R/S ratio in V1 > 1 (with R > 0.7mm)
S in V5 or V6 > 0.7mm
R in V5 or V6 < 0.4mm with S in V1 < 0.2mm
right axis deviation (RAD) > +110deg
P pulmonale
S1S2S3 pattern (NB. this pattern may also be seen in normal patients or those with chronic obstructive pulmonary disease (COPD))