We often face this finding in asymptomatic and otherwise healthy individuals and the causes may vary from benign nonpathological variants to severe or life threatening heart diseases such as brugada syndrome or arrhythmogenic right ventricular dysplasia.
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This patient had primary pulmonary hypertension.
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There are no universally accepted criteria for diagnosing rvh in the presence of rbbb.
Ecg changes seen in left ventricular hypertrophy lvh and right ventricular hypertrophy rvh.
Tall r waves greater than limits for patient s age in right sided leads v4r and v1 deep s waves greater than limits for patient s age in left sided leads v5 and v6.
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Increased r s ratio greater than upper limits for child s age in v1 2.
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Rad for the patients age.
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Look at the qrs in v1 there is an rsr pattern indicating right ventricular hypertrophy.
The electrical vector of the left ventricle is enhanced in lvh which results in large r waves in left sided leads v5 v6 avl and i and deep s waves in right sided chest leads v1 v2.
Voltage criteria must be accompanied by non voltage criteria to be considered diagnostic of lvh.
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Criteria for diagnosing lvh.
The standard voltage criteria do not apply.
One of the more frequent dilemmas in ecg interpretation is the differential diagnosis of an rsr pattern in leads v1 v2.
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Abnormal r s ratio in favour of rvh.
Note that the qrs are the right width however there is a pure r wave in v1 indicating rvh.
However the presence of incomplete complete rbbb with a tall r wave in v1 right axis deviation of 110 or more and supporting criteria such as rv strain pattern or p pulmonale would be considered suggestive of rvh.
There are numerous criteria for diagnosing lvh some of which are summarised below.
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