Right heart failure electrocardiogram: Difference between revisions
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Right heart failure is often accompanied by [[right ventricular hypertrophy]] and right ventricular dilation. The general electrocardiographic findings of [[right ventricular hypertrophy]] include [[right axis deviation]], an R/S ratio > 1 in V1, and the presence of [[P pulmonale]]. | Right heart failure is often accompanied by [[right ventricular hypertrophy]] and right ventricular dilation. The general electrocardiographic findings of [[right ventricular hypertrophy]] include [[right axis deviation]], an R/S ratio > 1 in V1, and the presence of [[P pulmonale]]. | ||
== Summary of EKG Criteria for [[RVH]] == | ==Electrocardiogram== | ||
=== Summary of EKG Criteria for [[RVH]] === | |||
# [[Right axis deviation]] of +90 degrees or more | # [[Right axis deviation]] of +90 degrees or more | ||
# The R wave in V1 is 7 mm or more in height | # The R wave in V1 is 7 mm or more in height | ||
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# S1 S2 S3 pattern in children | # S1 S2 S3 pattern in children | ||
== Differential Diagnosis of R>S in V1 == | === Differential Diagnosis of R>S in V1 === | ||
# [[RVH]] | # [[RVH]] | ||
# [[Acute myocardial infarction|Posterior MI]] | # [[Acute myocardial infarction|Posterior MI]] | ||
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# RV strain can be seen in leads V1 and V2 but also in leads 2,3, aVF | # RV strain can be seen in leads V1 and V2 but also in leads 2,3, aVF | ||
==Electrocardiographic Examples of [[RVH]]== | ===Electrocardiographic Examples of [[RVH]]=== | ||
<div align="center"> | <div align="center"> | ||
<gallery heights="175" widths="175"> | <gallery heights="175" widths="175"> | ||
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==The EKG in Right atrial enlargement== | ===The EKG in Right atrial enlargement=== | ||
Right atrial enlargement is defined as either: | Right atrial enlargement is defined as either: | ||
Revision as of 20:49, 25 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Right heart failure is often accompanied by right ventricular hypertrophy and right ventricular dilation. The general electrocardiographic findings of right ventricular hypertrophy include right axis deviation, an R/S ratio > 1 in V1, and the presence of P pulmonale.
Electrocardiogram
Summary of EKG Criteria for RVH
- Right axis deviation of +90 degrees or more
- The R wave in V1 is 7 mm or more in height
- 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 P congenitale
- S1 S2 S3 pattern in children
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
Electrocardiographic Examples of RVH
-
Right ventricular hypertrophy -
Right ventricular hypertrohpy, the R wave > the S wave in V1
The EKG in Right atrial enlargement
Right atrial enlargement is defined as either:
-
Right atrial enlargement -
Right atrial enlargement
-
Right Atrial Enlargement
