Right Ventricular Hypertrophy with Strain - ECG

ECG Criteria
Tall R wave in V1 > 7 mm (also deep S in V5 or V6).

Other Criteria
• R/S ratio in V1 > 1 (R is > S in V1).
• R in V1 + S in V5 or V6 is equal to or > 10.5 mm.
• R in aVR > 5 mm.
• S in V1 < 2 mm.
• Incomplete RBBB (rSR in V1).
• QRS-wide.
• Small q in V1.
• Right axis deviation (between + 90° and + 180°).



Causes Of  Right Ventricular Hypertrophy:
• Chronic cor pulmonale.
• Mitral stenosis with pulmonary hypertension.
• Pulmonary hypertension (due to any cause).
• Pulmonary stenosis.
• Eisenmenger’s syndrome.
• Fallot’s tetralogy.
• ASD.
• VSD.
• Tricuspid regurgitation.


Clinical Diagnosis Of  Right Ventricular Hypertrophy:
On palpation of precordium there will be
• Left parasternal heave.
• Epigastric pulsation.

Right Ventricular Hypertrophy with Strain
• Features of RVH.
• ST depression and T inversion (in V1 and V2).