RVH or Posterior MI? Make the Diagnosis

Kyuhyun Wang, MD

Disclosures

April 20, 2012

Answer

Right ventricular hypertrophy

Discussion

In this tracing, QRS axis tends to the right axis deviation (RAD), which should make one think of right ventricular hypertrophy (RVH) first. After the RAD, all other diagnostic features of RVH are found in the precordial leads, namely tall R waves in the right precordial leads, a deep S wave in V6, and downsloping ST-T changes that are more prominent in the right precordial leads. This tracing has all of these features and is from a patient with primary pulmonary hypertension with RVH. In a tracing of acute posterior myocardial infarction, the ST segment is depressed more horizontally, and RAD and a deep S wave in V6 are not part of it.

Comments

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