Precordial Lead Patterns in Right Ventricular Hypertension

CURRENT criteria for the electrocardiographic diagnosis of right ventricular hypertrophy -3 depend primarily upon abnormal axis deviation and changes in the right precordial leads (V1, V4.R7). The R/S ratio in these leads has proved to be of great value in the recognition of right ventricular hypertrophy. Various patterns (qR, rS, rsR', Rs) are encountered and many theories have been put forward to explain the exact mechanisms producing them. Attempts have also been made to correlate specific electrocardiographic patterns with specific hemodynamic changes. The concept of systolic and diastolic overload patterns introduced by Cabrera and Monroy4 correlated resistance to right ventricular outflow (systolic overloading) with a high R wave in V1, while dilatation of the ventricle (diastolic overload) was associated with the rsR' pattern. Although this is a useful physiologic concept, many authors have shown that each of these patterns is found in both hemodynamic situations and these attempts at correlation are not always successful. In this paper our findings in cases with right ventricular hypertension are presented with an attempt to correlate the right precordial electrocardiogram with the pressure in the right ventricle. The significance of the various patterns found will be discussed.