Right Ventricular Strain

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).


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

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

LITFL Further Reading

Advanced Reading




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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