Right Ventricular Hypertrophy RVH

Right ventricular hypertrophy (Fig. 5.12) is less common than left ventricular hypertrophy. RVH is often accompanied by right atrial abnormality and tall R waves in lead Vi (height of R wave depth of S wave), and right axis deviation. In more severe cases ST segment depression and T wave inversion, indicating strain pattern can sometimes be seen (Fig. 5.13). 

To determine the voltage criteria for RVH the R wave in lead Vi is added to the S wave in lead Ve. If the sum is 10 mm or more then the voltage criteria for RVH is present. This can be seen in Fig. 5.11. 

12 A normal heart (left) and a heart with RVH (right) 

Right axis deviation Tall R waves in lead Vi 

R wave in Vi + S wave in Ve 10 mm in height Accompanied right atrial abnormality 

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Symptoms of pulmonary hypertension include dyspnea on exertion, chest pain, palpitations, syncope, ascites and lower extremity edema. Anginal symptoms may occur and are thought to be due to increased RV oxygen demand, decreased right coronary artery perfusion due to decreased pressure difference between aorta and RV end diastolic pressure, and rare instances of compression of the left main coronary artery by the dilated pulmonary trunk. Right ventricular hypertrophy (RVH) correlates with EKG findings including RV... 

Lung disease - pulmonary HTN — T right ventricular pressure - right ventricular hypertrophy (RVH) -> nght-sided heart failure. 

PRN When necessary, as needed (pro re nata) RVH Right ventricular hypertrophy... 

Abbreviations MM, multiple myeloma RV dil, right ventricular dilatation Cath, right heart catheterization CCB, calcium channel blocker dig, digoxin dx, diagnosis LVH/RVH, left ventricular hypertrophy/right ventricular hypertrophy. 

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