Biventricular hypertrophy ECG and clinical characteristics

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Biventricular hypertrophy

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

In case the ECG or other examinations suggest left ventricular hypertrophy (LVH), one should suspect concomitant right ventricular hypertrophy (RVH) if the following ECG criteria are presented:

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

Figure 1. ECG changes seen in left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH). The electrical vector of the left ventricle is enhanced in LVH, which results in large R-waves in left sided leads (V5, V6, aVL and I) and deep S-waves in right sided chest leads (V1, V2). Right ventricular hypertrophy causes large R-waves in right sided chest leads and deeper S-waves in left sided leads.