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ECG Findings

  • Rightward axis

  • Dominant S wave in lateral leads (V5, V6, I, aVL)

  • Dominant R wave in aVR, V1, V2, which may exceed the S-wave amplitude (especially in lead V1)

  • T-wave inversions in relation to QRS complex


  1. Right ventricular hypertrophy (RVH) causes characteristic ECG changes as the predominant electrical signal of the left ventricle is overcome.

  2. Congenital heart disease, pulmonic or mitral stenosis, and pulmonary hypertension are common causes of RVH.

  3. As RVH persists, right atrial enlargement may occur as seen in the example (P-wave amplitude in V1 > 1.5 mm).


Right Ventricular Hypertrophy. (ECG contributor: James V. Ritchie, MD.)


The R-wave amplitude exceeds the S-wave amplitude (arrows) in lead V1. In addition, the P-wave upward deflection exceeds 1.5 mm, indicating concomitant right atrial enlargement.

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