Tachycardia, S1Q3T3, tall P wave in II, ST elevation in right-sided leads (aVR, V1, III), right axis deviation, new right bundle branch block, new incomplete right bundle branch block, and T wave inversions especially in the inferior and right-sided precordial leads (II, III, aVF, V1, V2, and V3) have all been suggested as right heart strain patterns.
Pulmonary Embolism

Examples

Pulmonary Embolism
Anterior precordial and inferior T-wave inversions are common findings of acute right heart strain. This patient had a submassive pulmonary embolism.
Pulmonary Embolism
This patient was discovered to have a pulmonary embolism with right heart strain. The ECG demonstrates early R wave progression, right axis deviation, right atrial enlargement, ST-segment depressions and T-wave inversions in inferolateral leads – all consistent with right heart strain.