Right Ventricular Hypertrophy

Updated October 23, 2019

Background | Causes | Diagnostic Criteria | Associated Findings | Examples | Further Reading

Background

• Pathologic increase in right ventricular muscle mass
• Direction of forces changed to the right and anterior
• Manifests as larger R-wave and smaller S-wave in V1 and larger S-wave and smaller R-wave in V6.

Causes

• Congenital Cardiomyopathies
• Right Valvular Heart Diseases
• Cor Pulmonale
• Pulmonary hypertension

Diagnostic Criteria

Multiple criteria devised and no one can reliably screen, but more criteria positive, more likely the diagnosis. Most common criteria:

1. QRS Axis ≥ 110° (S>R height in I)
2. V1 => R>S in height (R/S > 1) and/or S in V1 < 2mm and/or R ≥ 7mm
3. V6 => S>R in amplitude (R/S ≤ 1) and/or S in V5-V6 > 7mm
4. P-wave of RAE

Associated Findings

• RBBB
• Repolarization Abnormalities (ST depressions, TWI)

Examples

Further Reading

• Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy. Journal of the American College of Cardiology. 2009; 53(11):992-1002.