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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Voltage criteria must be accompanied by non voltage criteria to be considered diagnostic of lvh.
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Rad for the patients age.
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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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.
Look at the qrs in v1 there is an rsr pattern indicating right ventricular hypertrophy.
This patient had primary pulmonary hypertension.
Abnormal r s ratio in favour of rvh.
There are numerous criteria for diagnosing lvh some of which are summarised below.
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Lmca left main coronary artery occlusion st elevation in avr.
The standard voltage criteria do not apply.
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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.
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The most commonly used are the sokolov lyon criteria s wave depth in v1 tallest r wave height in v5 v6 35 mm.
Note that the qrs are the right width however there is a pure r wave in v1 indicating rvh.
Criteria for diagnosing lvh.
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Syncope shock and chest pain.
If we look at avf the qrs is biphasic.
There are no universally accepted criteria for diagnosing rvh in the presence of rbbb.
