Right Ventricular Hypertrophy

Background

  • Pathologic increase in right ventricular muscle mass
  • Direction of forces changed to the right and anterior
  • Manifests as larger R-wave and smaller S-wave in V1 and larger S-wave and smaller R-wave in V6.

Causes

  • Congenital Cardiomyopathies
  • Right Valvular Heart Diseases
  • Cor Pulmonale
  • Pulmonary hypertension

Diagnostic Criteria

Multiple criteria devised and no one can reliably screen, but more criteria positive, more likely the diagnosis. Most common criteria:

  1. QRS Axis ≥ 110° (S>R height in I)
  2. V1 => R>S in height (R/S > 1) and/or S in V1 < 2mm and/or R ≥ 7mm
  3. V6 => S>R in amplitude (R/S ≤ 1) and/or S in V5-V6 > 7mm
  4. P-wave of RAE
 Note: rSr’ in V1 requires a differential diagnosis (If QS morphology in V1 with S in V6, R-axis, RAE would suggest RVE to be the cause of rSr’).

Associated Findings

  • RBBB
  • Repolarization Abnormalities (ST depressions, TWI)

Examples

Right Axis DeviationRight axis deviation

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Further Reading

  • Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy. Journal of the American College of Cardiology. 2009; 53(11):992-1002. 
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