Right ventricular hypertrophy (RVH) refers to an abnormal enlargement or pathologic increase in muscle mass of the right ventricle in response to pressure overload.
As per echo examination, the right ventricular wall is thicker than 5mm.
Etiology
pulmonary hypertension with or without left ventricular dysfunction
conditions that affect the tricuspid valve leading to significant tricuspid regurgitation
congenital heart disease (Transposition of great arteries, pulmonary stenosis, etc.)
chronic lung disease
ECG manifestation
right axis deviation (greater than 110°)
dominant R in V1 (R> 7mm , R/S ratio is > 1)
dominant S in V5/V6 (S > 7 mm, R/S ratio < 1)
Secondary changes:
P pulmonale (> 2.5mm) due to right atrium enlargement
right ventricular strain pattern in V1-V3/V4, sometimes II, III, aVF - ST depression/ T wave inversion
SI, S II, S III pattern - dominant S waves in leads I, II, III
complete or incomplete RBBB
Other possible causes of an R/S ratio of > 1 in in lead V1:
Posterior wall MI (also causes ST depression in V1-V3, but T waves symmetrically inverted and the patient would be presenting with chest pains)
Right bundle branch block
Wolff-Parkinson-White Type A
Lead misplacement (if V1 is placed too high)
Isolated posterior wall hypertrophy (occurs in Duchenne's muscular dystrophy)
ECG 1 Right ventricular hypertrophy on ECG
ECG 2 Right ventricular hypertrophy on ECG
References
Bhattacharya PT, Ellison MB. Right Ventricular Hypertrophy. [Updated 2020 Aug 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499876/
