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Simultaneous hypertrophy of the left and right ventricle is rather common. The ECG has low sensitivity with respect to detecting biventricular hypertrophy. This is because the strong and oppositely directed forces tend to cancel each other out. However, the ECG may show features characteristic of biventricular hypertrophy.
Biventricular hypertrophy ECG
- Right axis deviation (>90°) – This never occurs in LVH.
- Deep S-wave in V5 or V6 (>6 mm)
- Large RS complexes in multiple leads
- P pulmonale