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t o r e g . c o m
Dr. Mete ALPASLAN
Right Ventricular Hypertrophy - RVH
ECG criteria for the diagnosis of right ventricular hypertrophy
Right axis deviation +90 degrees or more.
Right atrial abnormality
R in C1 >0.7mV (>7mm).
QR in C1.
R/S ratio in C5 or C6 is <1 .
R/S ratio in C1 is >1 with R >0.5mV (>5mm).
S in C5 or C6 is >0.7mV (>7mm).
S1S2S3 pattern.
S1Q3 pattern.
R in C5 or C6 is >0.4mV with S in C1 >0.2mV.
Reference
Am J Cardiol 1984;53:1140.
ECG 1. The ECG above belongs to a 2 years old girl who underwent a successful operation for closure of the atrial septal defect
(ASD) recently. The ECG shows several signs of RVH: right axis deviation, S1S2S3 pattern , QR in C1 , S in C5 or C6 >0.7mV
(>7mm) , R in C1 >0.7mV (>7mm) .
This ECG has been donated by Pediatric Cardiologist Dr. Mahmut Gokdemir to our website.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 5 months-old child with pulmonary stenosis. The maximum systolic gradient at the level of
pulmonary valve was 54 mmHg. The ECG shows right axis deviation and right ventricular hypertrophy.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a 6 years-old girl with severe pulmonary stenosis. The peak systolic pulmonary valve
gradient is 120 mmHg. The ECG shows right ventricular hypertrophy. This patient also has right to left shunt flow through an
atrial septal defect.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 4. The ECG above belongs to a 6 months-old child who had undergone cutting balloon for pulmonary stenosis. He also
has inferior type Total Anomalous Pulmonary Venous Drainage. Echocardiography revealed dilated right heart chambers.
The ECG shows right ventricular hypertrophy and right atrial abnormality.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 5. The ECG above belongs to a 7 years-old who had been operated for TGA after which he develeoped neopulmonary
stenosis with a peak systolic gradient of 170 mmHg. Echocardiography revealed dilated right heart chambers in this patient.
The ECG shows right ventricular hypertrophy.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 20 years-old man with severe congenital pulmonary stenosis resulting in significant
right ventricular hypertrophy with right atrial dilatation. Echocardiography measured pulmonary valve peak systolic gradient
as 178 mmHg. The ECG shows tall P waves in lead II indicating right atrial abnormality . Right axis deviation is also seen.
Chest leads are recorded at a calibration of 5 mm/mV.
Click here for a more detailed ECG
The ECG above has been used with the permission of Anatolian Journal of Cardiology and AVES Publishing.
Click here to read the relevant article of Dr. Ozturk et al.
ECG 7. The ECG above belongs to a 18 years-old girl with congenital pulmonary stenosis. The maximum systolic gradient at the
level of pulmonary valve was 90 mmHg and the mean gradient was 60mmHg. The ECG shows right axis deviation and
right ventricular hypertrophy.
Click here for a more detailed ECG
ECG 8. The ECG above belongs to a 74 years-old man with chronic obstructive pulmonary disease (COPD), hypertension and
coronary artery disease. It suggests right ventricular hypertrophy. ECHOcardiography showed dilated right ventricle
and right atrium. The left ventricular dimensions and systolic function was normal.
The P wave axis is 74 degrees and the QRS axis is 114 degrees.
ECG criteria for the diagnosis of right ventricular hypertrophy
Right axis deviation +90 degrees or more.
Right atrial abnormality
R in C1 >0.7mV (>7mm).
QR in C1.
R/S ratio in C5 or C6 is <1 .
R/S ratio in C1 is >1 with R >0.5mV (>5mm).
S in C5 or C6 is >0.7mV (>7mm).
S1S2S3 pattern.
S1Q3 pattern.
R in C5 or C6 is >0.4mV with S in C1 >0.2mV.
Reference
Am J Cardiol 1984;53:1140.
ECG 1. The ECG above belongs to a 2 years old girl who underwent a successful operation for closure of the atrial septal defect
(ASD) recently. The ECG shows several signs of RVH: right axis deviation, S1S2S3 pattern , QR in C1 , S in C5 or C6 >0.7mV
(>7mm) , R in C1 >0.7mV (>7mm) .
This ECG has been donated by Pediatric Cardiologist Dr. Mahmut Gokdemir to our website.
Click here for a more detailed ECG
ECG 2. The ECG above belongs to a 5 months-old child with pulmonary stenosis. The maximum systolic gradient at the level of
pulmonary valve was 54 mmHg. The ECG shows right axis deviation and right ventricular hypertrophy.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 3. The ECG above belongs to a 6 years-old girl with severe pulmonary stenosis. The peak systolic pulmonary valve
gradient is 120 mmHg. The ECG shows right ventricular hypertrophy. This patient also has right to left shunt flow through an
atrial septal defect.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 4. The ECG above belongs to a 6 months-old child who had undergone cutting balloon for pulmonary stenosis. He also
has inferior type Total Anomalous Pulmonary Venous Drainage. Echocardiography revealed dilated right heart chambers.
The ECG shows right ventricular hypertrophy and right atrial abnormality.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 5. The ECG above belongs to a 7 years-old who had been operated for TGA after which he develeoped neopulmonary
stenosis with a peak systolic gradient of 170 mmHg. Echocardiography revealed dilated right heart chambers in this patient.
The ECG shows right ventricular hypertrophy.
Pediatric cardiologist Dr. Mahmut Gokdemir has donated this ECG to our website.
Click here for a more detailed ECG
ECG 6. The ECG above belongs to a 20 years-old man with severe congenital pulmonary stenosis resulting in significant
right ventricular hypertrophy with right atrial dilatation. Echocardiography measured pulmonary valve peak systolic gradient
as 178 mmHg. The ECG shows tall P waves in lead II indicating right atrial abnormality . Right axis deviation is also seen.
Chest leads are recorded at a calibration of 5 mm/mV.
Click here for a more detailed ECG
The ECG above has been used with the permission of Anatolian Journal of Cardiology and AVES Publishing.
Click here to read the relevant article of Dr. Ozturk et al.
ECG 7. The ECG above belongs to a 18 years-old girl with congenital pulmonary stenosis. The maximum systolic gradient at the
level of pulmonary valve was 90 mmHg and the mean gradient was 60mmHg. The ECG shows right axis deviation and
right ventricular hypertrophy.
Click here for a more detailed ECG
ECG 8. The ECG above belongs to a 74 years-old man with chronic obstructive pulmonary disease (COPD), hypertension and
coronary artery disease. It suggests right ventricular hypertrophy. ECHOcardiography showed dilated right ventricle
and right atrium. The left ventricular dimensions and systolic function was normal.
The P wave axis is 74 degrees and the QRS axis is 114 degrees.