RVH and LVH

GEDE PADMAWIJAYA
 Right Ventricular Hypertrophy
Diagnostic criteria
• Right axis deviation of +110° or more.
• Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
• Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
• QRS duration < 120ms (i.e. changes not due to RBBB).

Supporting criteria
• Right atrial enlargement (P pulmonale).
• Right ventricular strain pattern = ST depression / T wave inversion
in the right precordial (V1-4) and inferior (II, III, aVF) leads.
• S1 S2 S3 pattern = far right axis deviation with dominant S waves in
leads I, II and III.
• Deep S waves in the lateral leads (I, aVL, V5-V6).
 Right Ventricular Hypertrophy
Causes
• Pulmonary hypertension
• Mitral stenosis
• Pulmonary embolism
• Chronic lung disease (cor pulmonale)
• Congenital heart disease (e.g. Tetralogy of Fallot, pulmonary
stenosis)
• Arrhythmogenic right ventricular cardiomyopathy
RVH
RVH
RVH
RVH
 Right Ventricular Strain
Definition
Repolarisation abnormality due to right ventricular hypertrophy or
dilatation.

Electrocardiographic Features
• ST depression and T wave inversion in the leads corresponding to
the right ventricle, i.e
• The right precordial leads: V1-3, often extending out to V4
• The inferior leads: II, III, aVF, often most pronounced in lead III as
this is the most rightward-facing lead.
• NB. Compare this to the left ventricular strain pattern, where ST/T-
wave changes are present in the left ventricular leads (I, aVL, V5-6).
RVH
 Left Ventricular Hypertrophy
Background
• The left ventricle hypertrophies in response to pressure overload
secondary to conditions such as aortic stenosis and hypertension.
• This results in increased R wave amplitude in the left-sided ECG
leads (I, aVL and V4-6) and increased S wave depth in the right-
sided leads (III, aVR, V1-3).
• The thickened LV wall leads to prolonged depolarisation (increased
R wave peak time) and delayed repolarisation (ST and T-wave
abnormalities) in the lateral leads.
 Left Ventricular Hypertrophy
Criteria for Diagnosing LVH
• There are numerous criteria for diagnosing LVH, some of which are
summarised below.
• The most commonly used are the Sokolov-Lyon criteria (S wave
depth in V1 + tallest R wave height in V5-V6 > 35 mm).
• Voltage criteria must be accompanied by non-voltage criteria to be
considered diagnostic of LVH.

Causes of LVH
• Hypertension (most common cause), Aortic stenosis
• Aortic regurgitation, Mitral regurgitation
• Coarctation of the aorta
• Hypertrophic cardiomyopathy
LVH
LVH
LVH
LVH
LVH
LVH + STRAIN
LVH + STRAIN