What is right ventricular hypertrophy?

Right ventricular hypertrophy (RVH) refers to a pathological change in which the right ventricular myocardium proliferates and the ventricular wall thickens due to myocardial lesions or certain diseases that cause excessive volume/pressure load on the right ventricle. This condition is commonly seen in chronic pulmonary heart disease, pulmonary hypertension, and congenital heart disease.

RVH is a compensatory change of the heart, and severe cases may progress to right heart failure.

Active treatment of the underlying disease is essential to prevent or delay the occurrence and progression of RVH.

Which department should I visit for right ventricular hypertrophy?

English name: Right Ventricular Hypertrophy (RVH).

Aliases: Right ventricular hypertrophy, right ventricular thickening, right ventricular enlargement.

Department: Cardiology.

What causes right ventricular hypertrophy?

Myocardial lesions: Abnormal gene regulation leads to inappropriate proliferation of cardiomyocytes and ventricular remodeling.

Increased right ventricular volume or pressure load:

• Chronic pulmonary heart disease: Long-term chronic lung or thoracic conditions increase pulmonary circulation resistance, burdening the right heart and leading to RVH or even right heart failure.
• Primary/secondary pulmonary hypertension: Excessive pulmonary artery pressure obstructs right ventricular ejection, causing RVH due to prolonged overload.
• Congenital heart disease: Left-to-right shunt congenital heart diseases increase right ventricular pressure, leading to RVH.
• Valvular disease: Tricuspid valve prolapse, mitral stenosis, etc., can overload the right heart and cause RVH.

Who is most likely to develop right ventricular hypertrophy?

• Most common in patients with chronic lung diseases (e.g., chronic bronchitis, chronic obstructive pulmonary emphysema).
• Also seen in chronic pulmonary vascular diseases (pulmonary embolism, primary/secondary pulmonary hypertension), left-to-right shunt congenital heart diseases, and certain valvular diseases (tricuspid valve prolapse, mitral stenosis).
• May also occur in individuals with thoracic or spinal deformities and certain cardiomyopathy patients.

What are the main symptoms of right ventricular hypertrophy?

Compensated cardiac function stage: Most patients with RVH may show no specific symptoms, mainly presenting with underlying disease symptoms and ECG abnormalities.

Decompensated cardiac function stage: Symptoms of right heart failure may appear, such as lower limb edema, decreased appetite, hepatomegaly, jugular vein distension, and ascites.

How is right ventricular hypertrophy diagnosed?

1. Electrocardiogram (ECG): The primary method for detecting RVH. ECG findings may include:

   • Right axis deviation > 110 degrees;
   • QS, Qr, or qr pattern in V1 lead;
   • R/S ratio > 1 in V1 lead;
   • R/S ratio < 1 in V5 or V6 lead;
   • R/S or R/Q ratio > 1 in aVR lead;
   • P pulmonale;
   • Right bundle branch block;
   • With strain, ST-segment depression and abnormal T waves may appear in V1–V3 leads.

2. Echocardiography: Right ventricular free wall thickness > 5 mm during diastole suggests RVH.

How is right ventricular hypertrophy treated?

Treatment focuses on managing the underlying disease to reduce pressure or volume load on the right heart.

Patients with right heart failure should receive therapies to reduce cardiac load and correct heart failure with medications.

What complications can right ventricular hypertrophy cause?

• RVH with normal cardiac function may not significantly affect daily life, depending on the underlying disease.
• However, RVH often indicates progression or worsening of the underlying disease, leading to a poorer prognosis.
• Severe cases may develop right heart failure, progressing to total heart failure, limiting activity tolerance and lifespan.

How to prevent right ventricular hypertrophy?

Prevention focuses on actively treating the underlying disease. Whether or not right heart failure has occurred, avoid recurrent lung infections and overexertion, and maintain nutrition and immunity.