14 right ventricular hypertrophy – Welch Allyn Means ECG Physicians Manual for CP Series Electrocardiographs - User Manual User Manual
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MEANS Physicians Manual
Welch Allyn
18
2.14 Right ventricular hypertrophy
The diagnosis RVH is not subdivided in such an elaborate way as LVH is. A distinction
between probable and definite can be made.
Presence of left or right atrial overload helps to make the diagnosis of RVH, because it
provides circumstantial evidence. In the presence of RBBB, IRBBB or posterior infarction, the
program may issue a statement that RVH is still to be considered. A more definite statement
of RVH is ruled out, to prevent too much over-diagnosing.
Skip tests
if:
QRS duration
160 ms
or
QRS axis
0
or
test RBBB passed
or
test LBBB passed
Say:
“RVH”
if:
R/S ratio
1 in V1 and Q/R ratio
1 in V1
and
positive QRS amplitude in V1
500 µV
and
positive T amplitude < negative T amplitude in V1 and V2
or
positive QRS amplitude < S amplitude in V5 or V6
or
QRS axis
100
and
LAO or RAO
or
QRS axis
120
and
R amplitude < S amplitude in II
and
S amplitude in aVF
200 µV
and
S duration in aVF < 40 ms
and
tests for high-lateral, lateral, and inferior infarcts did not pass
Say:
“probable RVH”
if:
Q/R ratio
1 and R/S ratio
1 in V1
and
positive QRS amplitude in V1
1500 µV
and
positive T amplitude in V1 < 700 µV
or
Q/R ratio
1/2 and R/S ratio
2 in V1
and
positive QRS amplitude in V1
300 µV
and
positive T amplitude < negative T amplitude in V1
or
positive QRS amplitude < S amplitude in V5 or V6
or
QRS axis
80
and
positive T amplitude < negative T amplitude in V1 and V2
and
positive QRS amplitude < S amplitude in V5 or V6
and
S amplitude in aVF
200 µV
and
S duration in aVF < 40 ms
and
test for lateral infarct did not pass
or
QRS axis
100
and
LAO or RAO
Say:
“consider RVH”
if:
test RBBB passed
and
QRS axis
-45
and
positive T amplitude < negative T amplitude in V2
or
test IRBBB passed
and
positive QRS amplitude in V1
500 µV
and
positive QRS amplitude > negative QRS amplitude in V1
or
test posterior infarct passed
and
QRS axis > 100