Electrocardiographic findings in right ventricular hypertrophy

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Electrocardiographic findings in right ventricular hypertrophy
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Electrocardiographic findings in right ventricular hypertrophy

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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

Summary of Clues to RVH

  1. Right axis deviation of +90 degrees or more
  2. RV1 = 7 mm or more
  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

Electrocardiographic Findings in RVH



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Acknowledgement and Attribution Regarding Sources of Content

Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .