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Patient
64-year-old man with a chronic cor pulmonale (history of pulmonary embolism);
Trace
Atrial sinus activity, normal PR interval (190 ms), complete right bundle branch block pattern (QRS duration 180 ms, rsR' pattern in V1) with right ventricular hypertrophy (high amplitude R' wave in V1, very deep and wide S wave in leads I, V5, V6, markedly delayed intrinsicoid deflection in V1, repolarization disorders from V1 to V3);
Exergue
A major right axis deviation in a patient with a right bundle branch block can reflect the presence of right ventricular hypertrophy or an associated left posterior fascicular block. The presence of a high-amplitude R' wave is particularly suggestive of a right ventricular hypertrophy.
The electrical diagnosis of right ventricular hypertrophy is difficult in the presence of a right bundle branch block and is expressed only if the hypertrophy is anatomically significant.