Right Ventricular Hypertrophy (RVH)

Electrocardiographic Features

Diagnostic criteria
  • Right axis deviation of +110° or more.
  • Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
  • Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
  • QRS duration < 120ms (i.e. changes not due to RBBB).
Supporting criteria
  • Right atrial enlargement (P pulmonale).
  • Right ventricular strain pattern = ST depression / T wave inversion in the right precordial (V1-4) and inferior (II, III, aVF) leads.
  • S1 S2 S3 pattern = far right axis deviation with dominant S waves in leads I, II and III.
  • Deep S waves in the lateral leads (I, aVL, V5-V6).
Other abnormalities caused by RVH

ECG Pearl

There are no universally accepted criteria for diagnosing RVH in the presence of RBBB; the standard voltage criteria do not apply. 

However, the presence of incomplete / complete RBBB with a tall R wave in V1, right axis deviation of +110° or more and supporting criteria (such as RV strain pattern or P pulmonale) would be considered suggestive of RVH.


Causes


ECG Examples

Example 1
ECGH RVH Right ventricular hypertropy RV Strain

Typical appearance of RVH:


Example 2
ECG Right ventricular hypertrophy RVH 2
  • Right axis deviation (+150 degrees)
  • P pulmonale (P wave in lead II > 2.5 mm)
  • Incomplete RBBB
  • Right ventricular strain pattern with T-wave inversion and ST depression in the right precordial (V1-3) and inferior (II, III, aVF) leads.

This ECG was originally posted by Johnson Francis on Cardiophile.org.


Example 4
ECG ARVD ARVC RVH

Right ventricular hypertrophy in a patient with arrhythmogenic right ventricular cardiomyopathy (ARVC):

  • Right axis deviation.
  • R/S ratio in V1 > 1
  • Right ventricular strain pattern with T-wave inversion and ST depression in the right precordial (V1-3) and inferior (II, III, aVF) leads.

This ECG was originally posted by Jayachandran Thejus on the website HeartPearls.com.


Related Topics


References

  • Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. Review. PMID: 12016190

LITFL Further Reading


Advanced Reading


ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

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