Right Ventricular Hypertrophy

Diagnostic Criteria:

• right axis deviation

• dominant R wave in V1 (R/S>1)

• dominant S wave in V5 or V6 (R/S<1)

• QRS duration <120ms (cannot have RBBB)

Note that RVH also produces repolarization abnormality (ST/T wave changes). These should be discordant to the QRS complex. Evaluation for ischemia is similar to that of LVH (https://www.ccagem.com/resident-resources/ekg-epistemology/ventricular-hypertrophy). Note, however, that the QRS is typically more positive throughout the duration of the chest leads, so the patients do not have ST elevation in these leads.

Causes:

• primary pulmonary hypertension

• mitral stenosis

• pulmonary embolism

• chronic lung disease causing cor pulmonale

• congenital heart disease (tetralogy of Fallot, pulmonary stenosis)

• arrhythmogenic right ventricular cardiomyopathy

RVH is most commonly seen chronically on EKG's of patients with either primary pulmonary hypertension or chronic, severe COPD. If RVH is new, one should be highly concerned for a PE; in fact, this finding portends a worse prognosis for patients with PE.

Examples:

Further Reading:

https://litfl.com/right-ventricular-hypertrophy-rvh-ecg-library/

http://hqmeded-ecg.blogspot.com/search/label/Right%20Ventricular%20Hypertrophy