• Skip to main content
  • Skip to secondary menu
  • Skip to primary sidebar
  • Skip to footer

Life in the Fast Lane • LITFL • Medical Blog

Emergency medicine and critical care medical education blog

  • MENU
  • ECG
  • CCC
  • Top 100
  • PODCASTS
  • JOBS
  • TOX
  • PART ONE
  • INTENSIVE
Home | ECG Library | ECG Diagnosis | Right Ventricular Strain

Right Ventricular Strain

by Dr Ed Burns, last update March 16, 2019

↪  ECG Library Homepage

Electrocardiographic Features

Repolarisation abnormality due to right ventricular hypertrophy or dilatation. ST depression and T wave inversion in the leads corresponding to the right ventricle.

  • The right precordial leads:  V1-3, often extending out to V4
  • The inferior leads:  II, III, aVF, often most pronounced in lead III as this is the most rightward-facing lead.

**NB. Compare this to the left ventricular strain pattern, where ST/T-wave changes are present in the left ventricular leads (I, aVL, V5-6).

Causes

Associated with increased pulmonary artery pressures in the setting of acute or chronic right ventricular hypertrophy or dilatation:

  • Pulmonary hypertension
  • Mitral stenosis
  • Pulmonary embolism
  • Chronic lung disease (cor pulmonale)
  • Congenital heart disease (e.g. Tetralogy of Fallot, pulmonary stenosis)
  • Arrhythmogenic right ventricular cardiomyopathy

ECG Examples

Example 1
ECGH RVH Right ventricular hypertropy RV Strain

Right ventricular hypertrophy 

  • Typical right ventricular strain pattern: ST depression and T-wave inversion in V1-4 (plus lead III), in this case due to right ventricular hypertrophy.

Example 2
ECG Massive Pulmonary embolus RVH RV Strain
Acute right ventricular dilatation due to massive PE. 

Right ventricular strain pattern involving both the precordial and inferior leads:

  • T-wave inversions are seen in the right precordial (V1-4) and inferior leads (III, aVF) in this patient with acute right ventricular dilatation due to massive pulmonary embolism.

Related Topics

  • Right Ventricular Hypertrophy
  • The ECG in Pulmonary Embolism

LITFL Further Reading

  • ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
  • ECG A to Z by diagnosis – ECG interpretation in clinical context
  • ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
  • 100 ECG Quiz – Self-assessment tool for examination practice
  • ECG Reference SITES and BOOKS – the best of the rest

Advanced Reading

  • Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
  • Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
  • Wagner GS. Marriott’s Practical Electrocardiography 12e
  • Chan TC. ECG in Emergency Medicine and Acute Care
  • Rawshani A. Clinical ECG Interpretation
  • Mattu A. ECG’s for the Emergency Physician
  • Hampton JR. The ECG In Practice, 6e

ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

EKG Library

Share this:

  • Facebook
  • Twitter
  • LinkedIn
  • Print

Related

About Dr Ed Burns

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

Reader Interactions

Leave a Reply Cancel reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

  • Twitter
  • Facebook
  • Vimeo
  • LinkedIn
  • Twitter
  • Twitter
  • RSS Feed
AD vocortex 2

Recent Posts

Gender Equality in Healthcare

Paediatric Constipation

Pediatric CXR Cases 008

Funtabulously Frivolous Friday Five 301

Creativity in Fiction

Footer

RSS FEED  LITFL posts by EMAIL or RSS

RSS FEED  LITFL Review by EMAIL or RSS

RSS FEED  FFFF by EMAIL or RSS

#FOAMed Medical Education Resources by LITFL is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Based on a work at https://litfl.com

  • Twitter
  • Vimeo
  • Facebook
  • LinkedIn
  • Twitter
  • Twitter

Authors • Blog • Contact • Disclaimer

2018 Launch

  • 22,992,262 visitors

Copyright © 2019 · Powered by vocortex and iSimulate