Correct!
4. Right ventricular hypertrophy (RVH)

This ECG meets criteria for RVH with right axis deviation, dominant R wave in V1, Dominant S wave in V5 and V6.

Criteria for RVH (1):

• Right axis deviation of +110° or more.
• Dominant R wave in V1 (> 7mm tall or R/S ratio > 1).
• Dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1).
• QRS duration < 120ms (Changes not due to RBBB).

Some common causes of RVH include pulmonary hypertension, mitral stenosis, pulmonary embolism, cor pulmonale, and amyloidosis. It can also be a sequela of congenital heart disease, such as tetralogy of Fallot or pulmonary stenosis.

The ECGs do not show left ventricular hypertrophy (LVH). Criteria for LVH are numerous, but the most commonly used is the Sokolov-Lyon criteria (S wave in V1 plus R wave in V5-V6 >35mm) (2).

The ECGs show a normal sinus rhythm / tachycardia.

An echocardiogram was performed (Figure 4).

Figure 4. Representative apical 4 chamber echocardiographic views of the heart (diastole on the left and systole on the right).

What does echo most likely show? (Click on the correct answer to proceed to the fourth of seven pages)

1. Heart failure with reduced ejection fraction from ischemic heart disease
2. Infiltrative cardiomyopathy from amyloid disease
3. Isolated biatrial enlargement
4. Left ventricular hypertrophy from hypertension
5. Pulmonary hypertension with dilated right ventricle

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