II. Pathophysiology
- Increased right ventricular Muscle mass in response to increased right sided pressures
III. Findings
IV. Causes
- Pulmonary Hypertension
- Significant tricuspid regurgitation
V. Diagnostics: Electrocardiogram (EKG)
- Reversal of precordial pattern
- Tall R in V1 and V2 (R >=7 mm in V1) or qR pattern in lead V1
- Deep S in V5 and V6
- Total Rv1 + Sv6 (or Sv5) > 10.5 mm
- Late Intrinsicoid Deflection in V1 and V2 (V1 deflection > 0.035 seconds)
- Right Axis Deviation (>90 degrees)
- Normal QRS Duration
- Incomplete Right Bundle Branch Block
-
ST segment Depression in inferior leads (strain pattern)
- Upward convexity
- Inverted T Waves in V1 and V2
- Right atrial hypertrophy (P Pulmonale)
VI. Diagnostics: Echocardiogram
- Evaluate Tricuspid Valve for tricuspid regurgitation
- Evaluate Right chamber sizes and right ventricular function
- Estimate pulmonary artery systolic pressure
- Evaluate for concurrent left heart disease
VII. Management
- See Pulmonary Hypertension
- See Tricuspid Regurgitation
VIII. References
- Bhattacharya (2021) StatPearls, accessed 2/23/2021