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Right Ventricular Hypertrophy Right Ventricular Hypertrophy (Example 1) Right Ventricular Hypertrophy with Strain (Example 1) Right ventricular hypertrophy (RVH) occurs when the right ventricular wall thickens due to chronic pressure overload, similar to that of left ventricualr hypertrophy. RVH is diagnosed on ECG in the presence of a R-S ratio of > 1 in lead V1 in the absence of other causes or if the R wave in lead V1 is > 7 mm tall. The strain pattern occurs when the right ventricular wall is quite thick and the pressure is high as well. Strain causes ST segment depression and assymetric T wave inversions in leads V1 - V3.  Recall the other causes of an R-S ratio of > in in lead V1: 1) Posterior wall MI (also causes ST depression in V1-V3, but T waves symmetrically inverted and the patient would be presenting with chest pains) 2) Right bundle branch block 3) Wolff-Parkinson-White Type A 4) Lead misplacement (if V1 is placed too high) 4) Isolated posterior wall hypertrophy (occurs in Duchenne's muscular dystrophy) |
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