Right ventricular hypertrophy: Difference between revisions

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{{Infobox_Disease |
{{Infobox_Disease |
   Name          = {{PAGENAME}} |
   Name          = {{PAGENAME}} |
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{{SI}}
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{{CMG}}
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{{SK}} RVH, RV strain
{{SK}} RVH, RV strain


==Overview==
==Overview==
Right ventricular hypertrophy is a form of [[ventricular hypertrophy]] affecting the [[right ventricle]].
Right ventricular hypertrophy refers to thickening of the heart muscle of the [[right ventricle]].


==Pathophysiology==
==Pathophysiology==
Blood travels through the right ventricle to the [[lungs]]. If conditions occur which decrease [[pulmonary circulation]], meaning blood does not flow well from the heart to the lungs, extra stress can be placed on the right ventricle. This can lead to right ventricular hypertrophy.  
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==
==Causes of Right Ventricular Hypertrophy==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
* [[Pulmonary embolism]]


===Common Causes===
===Common Causes===
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{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[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]]
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Coal worker pneumoconiosis]], [[effects of high altitude on humans|high altitude]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cystic fibrosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Congenital heart disease]], [[cystic fibrosis]], [[Eisenmenger's syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Pulmonary embolism]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Paracoccidioidomycosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Scoliosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[effects of high altitude on humans|High altitude]], [[obstructive sleep apnea]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Bronchiectasis]], [[chronic obstructive pulmonary disease]], [[Churg-Strauss syndrome]], [[coal worker pneumoconiosis]], [[cor pulmonale]], [[cystic fibrosis]], [[effects of high altitude on humans|high altitude]], [[interstitial lung disease|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]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Churg-Strauss syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
* [[Atrial septal defect]]
* [[Atrial septal defect]]
* [[Bronchiectasis]]
* [[Bronchiectasis]]
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* [[Churg-Strauss syndrome]]
* [[Churg-Strauss syndrome]]
* [[Coal worker pneumoconiosis]]
* [[Coal worker pneumoconiosis]]
* [[Coarctation of the aorta]]<ref name="pmid125322">{{cite journal| author=Wood WC, Wood JC, Lower RR, Bosher LH, McCue CM| title=Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three. | journal=J Pediatr | year= 1975 | volume= 87 | issue= 2 | pages= 217-20 | pmid=125322 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=125322  }} </ref>
* [[Congenital heart disease]]<ref name="pmid12016190">{{cite journal| author=Harrigan RA, Jones K| title=ABC of clinical electrocardiography. Conditions affecting the right side of the heart. | journal=BMJ | year= 2002 | volume= 324 | issue= 7347 | pages= 1201-4 | pmid=12016190 | doi= | pmc=PMC1123164 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12016190  }} </ref>
* [[Congenital heart disease]]<ref name="pmid12016190">{{cite journal| author=Harrigan RA, Jones K| title=ABC of clinical electrocardiography. Conditions affecting the right side of the heart. | journal=BMJ | year= 2002 | volume= 324 | issue= 7347 | pages= 1201-4 | pmid=12016190 | doi= | pmc=PMC1123164 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12016190  }} </ref>
* [[Cor pulmonale]]
* [[Cor pulmonale]]
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* [[Effects of high altitude on humans|High altitude]]<ref name="pmid23892441">{{cite journal| author=Whayne TF| title=Cardiovascular Medicine at High Altitude. | journal=Angiology | year= 2013 | volume=  | issue=  | pages=  | pmid=23892441 | doi=10.1177/0003319713497086 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23892441  }} </ref>
* [[Effects of high altitude on humans|High altitude]]<ref name="pmid23892441">{{cite journal| author=Whayne TF| title=Cardiovascular Medicine at High Altitude. | journal=Angiology | year= 2013 | volume=  | issue=  | pages=  | pmid=23892441 | doi=10.1177/0003319713497086 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23892441  }} </ref>
* [[Hypoplastic left heart syndrome]]
* [[Hypoplastic left heart syndrome]]
* [[interstitial lung disease|Interstitial lung disease in children (ChILD)]]
* [[Left ventricular hypertrophy]] or dilation
* [[Left ventricular hypertrophy]] or dilation
* [[Miliary tuberculosis]]
{{col-break|width=33%}}
* [[Mitral stenosis]]
* [[Mitral stenosis]]
* [[Obesity hypoventilation syndrome]]
* [[Obstructive sleep apnea]]
* [[Obstructive sleep apnea]]
* [[Paracoccidioidomycosis]]
* [[Pickwickian syndrome]]
* [[Pickwickian syndrome]]
* [[Primary pulmonary hypertension]]
* [[Primary pulmonary hypertension]]
* [[Pulmonary embolism]]
* [[Pulmonary embolism]]<ref name="pmid6534760">{{cite journal| author=Tartulier M, Boutarin J, Ritz B| title=Chronic pulmonary thromboembolism. | journal=G Ital Cardiol | year= 1984 | volume= 14 Suppl 1 | issue=  | pages= 13-21 | pmid=6534760 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6534760  }} </ref>
* [[Pulmonary fibrosis]]
* [[Pulmonary fibrosis]]
* [[Pulmonary hypertension]]
* [[Pulmonary hypertension]]
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* [[Tricuspid regurgitation]]
* [[Tricuspid regurgitation]]
* [[Ventricular septal defect]]
* [[Ventricular septal defect]]
{{col-end}}


==Diagnosis==
==Diagnosis==
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Crowdiagnosis]]


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Latest revision as of 15:40, 11 June 2014

Right ventricular hypertrophy
Right Ventricular hypertrophy

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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.

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

Right ventricular hypertrophy
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

  1. ↑ http://www.lib.mcg.edu/edu/eshuphysio/program/section4/4ch7/s4ch7_32.htm
  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.
  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.
  4. ↑ Whayne TF (2013). "Cardiovascular Medicine at High Altitude". Angiology. doi:10.1177/0003319713497086. PMID 23892441.
  5. ↑ Tartulier M, Boutarin J, Ritz B (1984). "Chronic pulmonary thromboembolism". G Ital Cardiol. 14 Suppl 1: 13–21. PMID 6534760.


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