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Patient
57-year-old woman with primary pulmonary arterial hypertension;
Trace
This tracing shows a sinus rhythm, a first-degree atrioventricular block (PR-interval of 230 ms), a narrow QRS, a right ventricular hypertrophy with an axis deviated to the right (130°), a R/S ratio > 1 in V1, a R wave amplitude of 10 mm in V1 and 17 mm in V2, repolarization disorders in the right precordial leads (V1-V4);
Exergue
The diagnosis of right ventricular hypertrophy is based on the combined presence of signs present in limb leads and in precordial leads: QRS axis deviation to the right, decreased Lewis index and a particular pattern in right-sided precordial leads (tall R wave, R/S ratio> 1).
Right ventricular hypertrophy is expressed on the ECG by diminished left ventricular forces. Right ventricular hypertrophy is often associated with a clockwise rotation of the right ventricle which becomes anterior, the left ventricle being pushed posteriorly.