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Right Ventricular Strain EKG Pattern

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Right Ventricular Strain EKG Pattern, Electrocardiogram in Pulmonary Hypertension, S1-Q3-T3

  • See Also
  1. EKG in Pulmonary Embolism
  2. Electrocardiogram
  3. Pulmonary Embolism
  1. Right Ventricular Hypertrophy
  2. Right Bundle Branch Block (partial or complete)
  3. T Wave Inversion
    1. Typically in anterior leads (V1-4)
    2. May affect inferior leads (II, III, avF) in some cases
  4. Prominent P Waves
  5. ST Elevation in aVR
  6. Sinus Tachycardia
  7. Atrial Fibrillation
    1. Associated with worse prognosis in Pulmonary Hypertension and Pulmonary Embolism
  8. S1-Q3-T3 Pattern (early left posterior fascicle block)
    1. S Wave in lead I
    2. Q Wave in lead III
    3. T Wave Inversion in lead III
  • Causes
  1. Pulmonary Hypertension
  2. Pulmonary Embolism (only 20% of those with PE have RV strain pattern)
    1. However, more often seen in ED presentations, significant PE as well as missed PE Diagnosis
  • References
  1. Joshi and Dermark (2016) Crit Dec Emerg Med 30(8):3-12
  2. Orman and Kline in Herbert (2016) EM:Rap 16(10): 12
  3. Marchick (2010) Ann Emerg Med 55(4): 331-5 +PMID: 19766353 [PubMed]
  4. Shopo (2015) Acad Emerg Med 22(10): 1127-37 +PMID: 26394330 [PubMed]