Right ventricular hypertrophy on ECG is suggested by which lead pattern?

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Multiple Choice

Right ventricular hypertrophy on ECG is suggested by which lead pattern?

Right ventricular hypertrophy shifts the heart’s depolarization vector toward the right, so you see more activity coming from the right ventricle in the ECG. The pattern of a dominant R wave in the right precordial lead V1, together with a rightward QRS axis (right-axis deviation), best reflects this increased RV mass and its electrical effect. In V1, the R wave becomes large enough to be dominant (R/S ratio > 1), and the overall axis moves to the right, which are classic signs of RVH. Other patterns don’t fit RVH as well. A tall R wave in a lateral lead like aVL points toward left-sided changes rather than right, a deep S wave in V1 suggests the depolarization vector is not shifted right, and ST elevation in V2 is an acute injury pattern, not hypertrophy.

Right ventricular hypertrophy shifts the heart’s depolarization vector toward the right, so you see more activity coming from the right ventricle in the ECG. The pattern of a dominant R wave in the right precordial lead V1, together with a rightward QRS axis (right-axis deviation), best reflects this increased RV mass and its electrical effect. In V1, the R wave becomes large enough to be dominant (R/S ratio > 1), and the overall axis moves to the right, which are classic signs of RVH.

Other patterns don’t fit RVH as well. A tall R wave in a lateral lead like aVL points toward left-sided changes rather than right, a deep S wave in V1 suggests the depolarization vector is not shifted right, and ST elevation in V2 is an acute injury pattern, not hypertrophy.

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