Processes Producing Or Leading To Rv Hypertrophy And Enlargement

RV hypertrophy is manifest in the ECG only when the RV forces predominate over those of the left ventricle. Since the latter has, roughly, three times more mass than the former, the right ventricle may double in size (when the left ventricle is normal) or triple its weight (when there is significant LV hypertrophy) and still not result in the necessary requirements to pull the electrical forces anteriorly and to the right. For these reasons, RV hypertrophy cannot be recognized easily in adult patients. Despite these limitations, the ECG manifestations of RV hypertrophy or enlargement can be subdivided into the following main types1 (see Figs. 11-11, 11-12, and ; 11-16): (1) the posterior and rightward displacement of the QRS forces associated with low voltage, as seen in patients with pulmonary emphysema (Fig. 11-30), (2) the incomplete RBBB pattern with right-axis deviation occurring in patients with chronic lung disease and some congenital cardiac malformations resulting in volume overloading of the right ventricle (B+;B; Fig. 11-31), (3) the true posterior wall MI pattern with normal to low voltage of the R wave in Vj of mitral stenosis (&+;□; Fig. 11-32), and (4) and the classic RV hypertrophy and strain pattern seen in young patients with congenital heart disease (producing pressure overload) or in adult patients with high-pressure ("primary" pulmonary) hypertension (0+;B; Fig. 11-33). False patterns of RV hypertrophy may occur in patients with true posterior (basal) MI, complete RBBB with LPFB, and Wolff-Parkinson-White syndrome resulting from AV conduction through left free wall or posteroseptal accessory pathways.

Low Voltage Complexes Lung Emphysema

Figure 11-30: ECG taken on a patient with pulmonary emphysema showing slight right-axis deviation with small rS complexes in lead I, an electrically vertical heart position, overall tendency to low voltage, and rS complexes in all chest leads. (From Lemberg and Castellanos.151 Reproduced with permission from the publisher and authors.)

Figure 11-30: ECG taken on a patient with pulmonary emphysema showing slight right-axis deviation with small rS complexes in lead I, an electrically vertical heart position, overall tendency to low voltage, and rS complexes in all chest leads. (From Lemberg and Castellanos.151 Reproduced with permission from the publisher and authors.)

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Essentials of Human Physiology

Essentials of Human Physiology

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