Welch Allyn Cardioperfect Workstation, PEDMEANS ECG Interpretation Module - Physicians - User Manual - Manual (Page 18)

CardioPerfect Workstation
PEDMEANS ECG Interpretation Module Physicians Manual
DIR 80015051 Rev. C 18 / 55
2.11 Right ventricular hypertrophy (RVH)
In RVH, the voltage of the QRS complex in the leads that reflect the right ventricle (RV) is increased,
and the QRS axis is usually directed rightward. The RV occupies the right and anterior part of the
ventricular mass. Therefore, an increase in voltage of the R wave is found most prominent in V1, while
the S amplitude is increased in V6. However, due to cancellation of opposing electromotive forces only
changes in the RS ratio may be apparent. An increase in RS ratio in V1, and a decrease in RS ratio in
V6 suggest RVH. A qR pattern or pure R in V3R or V1 is strongly suggestive for RVH. From 3 days up
to 6 years an upright T-wave in V1 and V6 indicates RVH. Severe RVH is often associated with
repolarization disturbances (strain) in V3R, V1, and V2.
In the program, the degree of voltage abnormality and the presence of a mirror image determine the
severity of RVH. In the repolarization parameter the program tests for the presence and degree of ST
depression and T negativity in the leads V3R, V1, and V2. Strain scores are determined using the J-
and T-wave amplitudes.
For children below one month of age, the severity score is decreased by one point, because the
normal right-ventricular dominance in this age group makes the diagnosis of RVH difficult.
In the presence of a bundle branch block, the RVH tests will be skipped.
Skip tests
if:
RBBB
or LBBB
Say:
“RVH”
if: positive QRS amplitude in 1 of V3R, V1 > ULN + 200 µV
and negative QRS amplitude in V6 > ULN + 200 µV
or RS ratio in V6 < 0.8
or positive QRS amplitude in V1 > ULN + 200 µV
and upright T in V1, V6
and 3 days < age < 6 years
or positive QRS amplitude in V1 > ULN
and strain in 1 of V3R, V1, V2
or pure R or qR pattern in V1
and positive QRS amplitude in 1 of V3R, V1 > ULN + 200 µV
or negative QRS amplitude in V6 > ULN + 200 µV
or RS ratio in V6 < 0.8
or strain in 1 of V3R, V1, V2
or pure R or qR pattern in V3R
and RS ratio in V1 > 1.0
and positive QRS amplitude in 1 of V3R, V1 > ULN + 200 µV
or negative QRS amplitude in V6 > ULN + 200 µV
or RS ratio in V6 < 0.8
or strain in 1 of V3R, V1, V2
Say:
“probable RVH”
if: positive QRS amplitude in1 of V3R, V1 > ULN
or RS ratio in V1 > ULN
and negative QRS amplitude in V6 > ULN
or RS ratio in V6 < 1.0
or positive QRS amplitude in V1 > ULN
and upright T in V1, V6
and 3 days < age < 6 years
or positive QRS amplitude in 1 of V3R, V1 > ULN
and moderate strain in 1 of V3R, V1, V2
or positive QRS amplitude in V1 > ULN + 200 µV
and RS ratio in V6 < 1.0
or negative QRS amplitude in V6 > ULN + 200 µV
and RS ratio in V1 > 1.0
or pure R or qR pattern in V3R, V1