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).
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
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.
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.
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
- 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