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Right ventricular hypertrophy (RVH) refers to increased thickness of the right ventricular (RV) wall, typically in response to chronic pressure overload. It is a structural adaptation that may precede right heart failure if untreated.
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| Category | Examples |
|---|---|
| Congenital heart disease | Tetralogy of Fallot (TOF), pulmonary stenosis, Ebstein anomaly |
| Pulmonary disease | Chronic obstructive pulmonary disease (COPD), interstitial lung disease |
| Pulmonary hypertension | Primary (idiopathic) or secondary (e.g., left heart disease, PE) |
| Valvular heart disease | Pulmonary valve stenosis or regurgitation, tricuspid stenosis |
| Left heart failure | Leading to pulmonary venous hypertension |
| High-altitude dwellers | Chronic hypoxia-induced pulmonary vasoconstriction |
| Obstructive sleep apnea | Intermittent nocturnal hypoxia |
ECG findings:
| Criteria | Findings |
|---|---|
| Right axis deviation | QRS axis > +110° |
| R > S in V1 | Tall R wave in right precordial leads |
| Deep S in V6 | R:S ratio <1 in left precordial leads |
| Strain pattern | ST depression, T wave inversion in right precordial leads |
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RVH is typically diagnosed when RV free wall thickness >5 mm (measured in end-diastole, subcostal or parasternal long-axis view)
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| Modality | Imaging features |
|---|---|
| CXR | • Prominent RV border |
| • Elevated cardiac apex (RV pushes up LV) | |
| • Enlarged main pulmonary artery | |
| • Decrease in retrosternal space on lateral view | |
| Echo | • RV wall thickening >5 mm |
| • Flattening or leftward bowing of interventricular septum (esp. in systole) | |
| • Enlarged RV dimensions | |
| • RV outflow tract (RVOT) dilation | |
| • Associated conditions: TR, pulmonary hypertension | |
| CMR | Gold standard for RV wall thickness and volume |
| • RV mass, RV volumes and EF | |
| • Interventricular septal flattening ("D-sign") | |
| • Myocardial fibrosis (late gadolinium enhancement in arrhythmogenic RV cardiomyopathy) | |
| • RV hypertrophy distribution (e.g., apical sparing in pulmonary hypertension) | |
| CTA | Often used to assess pulmonary arteries and RV size |
| • RV enlargement | |
| • Wall thickening | |
| • Signs of pulmonary hypertension (e.g., PA diameter >29 mm) |