Right bundle branch block and right ventricular hypertrophy

Tracing
N° 26
Patient
64-year-old man with a chronic cor pulmonale (history of pulmonary embolism);
Comments

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.

In the presence of a complete right bundle branch block, the following signs are typical for hypertrophy:

- A high amplitude R' wave exceeding 15 mm in V1

- A very wide S wave in lead I

- A significant delay in intrinsicoid deflection in the right precordial leads

These various parameters are observed in this patient, with right ventricular hypertrophy frequently occurring in patients with chronic cor pulmonale.

Epigraph
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.
Right bundle branch block and right ventricular hypertrophy