Right ventricular hypertrophy

Introduction Right ventricular hypertrophy is generally the cause of pulmonary hypertension. If you have a long time, you can develop right ventricular hypertrophy. This is a kind of compensation and needs to deal with the primary disease. Normally, the right ventricular wall thickness is only 1/3 of the left ventricular wall, so the combined vector of the left and right ventricular depolarization points to the left and the lower. In the case of mild right ventricular hypertrophy, the depolarization potential of the left ventricle is still dominant, and the change of the integrated ECG vector is not obvious. Only when the right ventricular hypertrophy is quite obvious, will significantly affect the direction of the ECG integrated vector (biased to the right front), causing it to produce a characteristic change, which is why ECG is not sensitive enough to diagnose early right ventricular hypertrophy.

Cause

The cause of right ventricular hypertrophy:

General right ventricular hypertrophy is nothing more than an increase in right ventricular systolic load and right ventricular diastolic load.

There are three common causes:

One: pulmonary hypertension:

1. The most common acquired heart disease that can cause pulmonary hypertension, such as chronic pulmonary heart disease and rheumatic mitral stenosis.

2. Left to right shunts are late in congenital heart disease.

3. Primary pulmonary artery disease pressure.

Two: right ventricular high flow: such as tricuspid prolapse.

Three: pulmonary stenosis: such as tetralogy of Fallot, pulmonary stenosis.

Right ventricular hypertrophy is a compensatory change in the heart. Active treatment of primary disease should relieve right ventricular systolic or diastolic load. If you continue to worsen your condition, you can increase your right heart and cause heart failure.

an examination

Related inspection

Dynamic electrocardiogram (Holter monitoring) two-dimensional echocardiography

An electrocardiogram and echocardiographic examination were performed on patients with pulmonary heart disease to observe and compare the sensitivity of the two tests for the diagnosis of early right ventricular hypertrophy in pulmonary heart disease. Generally, cardiac hypertrophy is seen in an electrocardiogram or color Doppler ultrasound, but it may be caused by difficulty breathing, ventricular murmur, and the like.

1. QRS group shape and voltage changes:

(1) The transverse vector ring of right ventricular hypertrophy is biased to the right front, so the amount of change in the chest lead is prominent. Rv1 increased by >1.0mv, and Sv1 decreased or disappeared normally. The QRS complex of V1 can be of the Rs, R, rSR, and qR types. R/S is >1 on the V1 lead. Sv5 is deeper than normal. V5R/S<1, Rv1+Sv5>1.2mv, are reliable indicators for diagnosing right ventricular hypertrophy.

(2) RavR 0.5 mv (or R > q).

2. The right axis of the ECG axis can reach +110°, which is of great significance for the diagnosis of right ventricular hypertrophy.

3. V1 wall activation time > 0.03s.

4. The ST of V1 and V2 decreases, and Tv1 is inverted. It has reference value, and is sometimes common in II, III and avF.

Differential diagnosis

Differential diagnosis:

1, congenital heart disease: mild asymptomatic, physical examination found that severe cases may have difficulty breathing after exercise, purpura, syncope, etc., older children may have growth retardation.

2, right ventricular hypertrophy is a hypertrophic cardiomyopathy, characterized by ventricular muscle hypertrophy, typically in the left ventricle, with ventricular septum, occasionally concentric hypertrophy. Left ventricular cavity volume is normal or reduced. Occasionally lesions occur in the right Ventricular. Usually autosomal dominant.

3, pulmonary heart disease: pulmonary heart disease is caused by chronic bronchitis, obstructive emphysema, bronchiectasis, tuberculosis, bronchial asthma and pneumoconiosis, which causes right ventricular hypertrophy, and even develop heart disease of right heart failure.

An electrocardiogram and echocardiographic examination were performed on patients with pulmonary heart disease to observe and compare the sensitivity of the two tests for the diagnosis of early right ventricular hypertrophy in pulmonary heart disease. Generally, cardiac hypertrophy is seen in an electrocardiogram or color Doppler ultrasound, but it may be caused by difficulty breathing, ventricular murmur, and the like.

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