Right Ventricular Strain EKG Pattern

Aka: Right Ventricular Strain EKG Pattern, Electrocardiogram in Pulmonary Hypertension, S1-Q3-T3

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II. Diagnostics: Electrocardiogram (EKG)

  1. Right Ventricular Hypertrophy
  2. Right Bundle Branch Block (partial or complete)
  3. T Wave Inversion
    1. Typically in anterior leads (V1-4)
    2. May affect inferior leads (II, III, avF) in some cases
  4. Prominent P Waves
  5. ST Elevation in aVR
  6. Sinus Tachycardia
  7. Atrial Fibrillation
    1. Associated with worse prognosis in Pulmonary Hypertension and Pulmonary Embolism
  8. S1-Q3-T3 Pattern (early left posterior fascicle block)
    1. S Wave in lead I
    2. Q Wave in lead III
    3. T Wave Inversion in lead III

III. Causes

  1. Pulmonary Hypertension
  2. Pulmonary Embolism (only 20% of those with PE have RV strain pattern)
    1. However, more often seen in ED presentations, significant PE as well as missed PE Diagnosis

IV. References

  1. Joshi and Dermark (2016) Crit Dec Emerg Med 30(8):3-12
  2. Orman and Kline in Herbert (2016) EM:Rap 16(10): 12
  3. Marchick (2010) Ann Emerg Med 55(4): 331-5 +PMID: 19766353 [PubMed]
  4. Shopo (2015) Acad Emerg Med 22(10): 1127-37 +PMID: 26394330 [PubMed]

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