OzEMedicine - Wiki for Australian Emergency Medicine Doctors

see also:

• cardiology
• patterns of ECGs
• right axis deviation (RAD)

• RVH often results from chronic right-sided pressure overload

• 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))