Right ventricular hypertrophy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Synonyms and keywords: RVH, RV strain

Overview

Right ventricular hypertrophy refers to thickening of the heart muscle of the right ventricle.

Pathophysiology

Blood travels through the right ventricle to the lungs. If there is increased resistance to flow in the pulmonary circulation, the stress placed on the right ventricle can lead to right ventricular hypertrophy.

Causes of Right Ventricular Hypertrophy

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Pulmonary embolism

Common Causes

Causes by Organ System

Cardiovascular	Atrial septal defect, cardiac fibrosis, coarctation of the aorta, congenital heart disease, cor pulmonale, Eisenmenger’s syndrome, hypoplastic left heart syndrome, left ventricular hypertrophy or dilation, mitral stenosis, obstructive sleep apnea, primary pulmonary hypertension, pulmonary embolism, pulmonary hypertension, pulmonic regurgitation, pulmonic stenosis, tetralogy of Fallot, transposition of the great vessels, tricuspid regurgitation, ventricular septal defect
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	Coal worker pneumoconiosis, high altitude
Gastroenterologic	Cystic fibrosis
Genetic	Congenital heart disease, cystic fibrosis, Eisenmenger’s syndrome
Hematologic	Pulmonary embolism
Iatrogenic	No underlying causes
Infectious Disease	Paracoccidioidomycosis
Musculoskeletal/Orthopedic	Scoliosis
Neurologic	High altitude, obstructive sleep apnea
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	Bronchiectasis, chronic obstructive pulmonary disease, Churg-Strauss syndrome, coal worker pneumoconiosis, cor pulmonale, cystic fibrosis, high altitude, interstitial lung disease in children (ChILD), miliary tuberculosis, obesity hypoventilation syndrome, obstructive sleep apnea, paracoccidioidomycosis, Pickwickian syndrome, primary pulmonary hypertension, pulmonary embolism, pulmonary fibrosis, pulmonary hypertension, scoliosis
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Churg-Strauss syndrome
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Diagnosis

EKG Findings in Right Ventricular Hypertrophy

Shown below is a tracing from lead V1 which shows right ventricular hypertrohpy, with an R wave > the S wave in V1

Diagnostic Criteria for Right Ventricular Hypertrophy

Right axis deviation of +90 degrees or more
RV1 = 7 mm or more
RV1 + SV5 or SV6 = 10 mm or more
R/S ratio in V1 = 1.0 or more
S/R ratio in V6 = 1.0 or more
Late intrinsicoid deflection in V1 (0.035+)
Incomplete RBBB pattern
ST T strain pattern in 2,3,aVF
P pulmonale or Right atrial enlargement or P congenitale
S1 S2 S3 pattern in children
Tall R wave in V1 or qR in V1
R wave greater than S wave in V1
R wave progression reversal
Inverted T wave in the anterior precordial leads

Differential Diagnosis of R>S in V1

RVH
Posterior MI
WPW
HCM (septal hypertrophy)
Kulbertus’ block (septal fascicular block)
Duchennes Muscular Dystrophy
Normal variant
V4r may be a more useful and reliable than lead V1 in that it often reveals an r>s while v1 remains normal
An incomplete right bundle branch block in the right precordial chest leads may signal the development of RVH
In the limb leads right axis deviation develops and at times prominent Q waves simulating an IMI appear in leads 2,3, and aVF.
In children an S1 S2 S3 pattern (i.e. an S wave deeper than R in all 3 standard leads) is a reliable index of RVH
RV strain can be seen in leads V1 and V2 but also in leads 2,3, aVF

References

↑ http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch7/s4ch7_32.htm
↑ ^2.0 ^2.1 ^2.2 ^2.3 Harrigan RA, Jones K (2002). “ABC of clinical electrocardiography. Conditions affecting the right side of the heart”. BMJ. 324 (7347): 1201–4. PMC 1123164. PMID 12016190.CS1 maint: PMC format (link)
↑ Wood WC, Wood JC, Lower RR, Bosher LH, McCue CM (1975). “Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three”. J Pediatr. 87 (2): 217–20. PMID 125322.
↑ Whayne TF (2013). “Cardiovascular Medicine at High Altitude”. Angiology. doi:10.1177/0003319713497086. PMID 23892441.
↑ Tartulier M, Boutarin J, Ritz B (1984). “Chronic pulmonary thromboembolism”. G Ital Cardiol. 14 Suppl 1: 13–21. PMID 6534760.

Template:WikiDoc Sources

[1] ttp://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch7/s4ch7_32.htm

[pmid12016190-2] 2.0 ^2.1 ^2.2 ^2.3 Harrigan RA, Jones K (2002). “ABC of clinical electrocardiography. Conditions affecting the right side of the heart”. BMJ. 324 (7347): 1201–4. PMC 1123164. PMID 12016190.CS1 maint: PMC format (link)

[pmid125322-3] Wood WC, Wood JC, Lower RR, Bosher LH, McCue CM (1975). “Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three”. J Pediatr. 87 (2): 217–20. PMID 125322.

[pmid23892441-4] Whayne TF (2013). “Cardiovascular Medicine at High Altitude”. Angiology. doi:10.1177/0003319713497086. PMID 23892441.

[pmid6534760-5] Tartulier M, Boutarin J, Ritz B (1984). “Chronic pulmonary thromboembolism”. G Ital Cardiol. 14 Suppl 1: 13–21. PMID 6534760.

[1]

[2]

[3]

[4]

[5]