• Right Ventricle
• Concentric Hypertrophy of the Right Ventricle
• Eccentric Hypertrophy of the Right Ventricle
• Main Ventricular Vector and Ventricular Hypertrophy
• Right Ventricular Hypertrophy
• ECG and Right Ventricular Hypertrophy
• Dominant R Wave in V1
• Deep S Wave in V5/V6
• Right Ventricular Overload and Concentric RV Hypertrophy
• Inferior Wall Infarction

Right Ventricle

• The right ventricle has a physiological thickness of 3-4mm
• Hemodynamic overload of the ventricle (volume, pressure) causes remodeling of the ventricle
• Right ventricular hypertrophy
• It is thickening of the wall > 5mm
• The wall of the right ventricle has a physiological thickness of 3-4mm
• Left ventricular hypertrophy
• It is thickening of the wall > 12mm
• The wall of the left ventricle has a physiological thickness of 10-12mm
• According to hemodynamic overload, we know 2 variants of hypertrophy:
• Concentric hypertrophy
• Eccentric hypertrophy

Eccentric Hypertrophy of the Right Ventricle

• The ventricle is overloaded with volume (increased preload)
• In diastole, it is overfilled with blood
• During systole, it pumps a larger volume of blood, also experiencing pressure overload
• Dilation and hypertrophy of the ventricular cavity occurs
• With chronic volume overload, only dilation occurs
• Eccentric hypertrophy of the RV, causes:
• Pulmonary insufficiency
• Eccentric hypertrophy of the LV, causes:
• Aortic insufficiency

Right Ventricular Hypertrophy

• ECG does not differentiate concentric hypertrophy from eccentric hypertrophy
• The myocardium of the right ventricle (even with RV hypertrophy) is smaller than the myocardium of the left ventricle
• The main cardiac vector, even with RV hypertrophy, does not point directly to the right ventricle
• therefore, ECG changes in RV hypertrophy are minimal
• ECG has only an orientational significance in the diagnosis of RV hypertrophy
• Echocardiography is used for the diagnosis of hypertrophy
  
  
• The principle of ECG diagnosis of RV hypertrophy is that the cardiac vector rotates:
• Towards the right leads (aVR, III, V1-V2)
• The R wave increases
• Away from the lateral leads (I, aVL, V5-V6)
• The R wave decreases

Dominant R Wave in V1

• Dominant R wave in V1 ≥ 7mm (R/S ratio in V1 ≥ 1)
• Right ventricular overload (V1-3)
• Descending ST depressions
• Negative T waves

Right Ventricular Hypertrophy

• Dominant R wave in V1 ≥ 7mm
• Deep S wave in V5/V6 ≥ 7mm
• Right axis deviation > +110°
• Negative QRS in leads I and aVL
• Right ventricular overload
• Negative T waves in V1-2 without ST depressions

Inferior Wall Infarction

• Similar ECG changes to RV hypertrophy can be seen in inferior wall infarction (V1-3):
• Dominant R wave in V1 ≥ 7mm (R/S ratio in V1 ≥ 1)
• Horizontal ST depressions
• Positive T waves (RV hypertrophy has negative T waves)
• In inferior wall infarction, almost always there is an associated inferior wall infarction (ST elevations in II, III, aVF)
• Because the posterior and inferior walls have a common blood supply through branches of the right coronary artery

Right Ventricular Hypertrophy

• Dominant R wave in V1 ≥ 7mm
• Deep S wave in V5/V6 ≥ 7mm
• Right axis deviation > +110°
• Negative QRS in leads I and aVL
• Right ventricular overload (V1-3)
• Descending ST depressions
• Negative T waves

Right Ventricular Hypertrophy and Right Bundle Branch Block

• Incomplete Right Bundle Branch Block:
• rsR´ in V1
• QRS duration < 0.12s
• Incomplete RBBB with R´ in V1 ≥ 10 mm
• Right axis deviation > +110°
• Negative QRS in leads I and aVL
• Right ventricular overload (V1-3) and (II, III, aVF)
• Descending ST depressions
• Negative T waves
• P pulmonale
• Height of P wave in II > 2.5mm