Right Heart Strain

Back to Glossary

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.

Examples

ECG Showing Right Heart Strain

Right Heart Strain

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.
ECG Showing Right Heart Strain

Right Heart Strain

Anterior precordial and inferior T-wave inversions are common findings of acute right heart strain. This patient had a submassive pulmonary embolism.
ECG Showing Global Subendocardial Ischemia

Global Subendocardial Ischemia Due to Pulmonary Embolism

There are diffuse ST-segment depressions along with ST-segment elevation in aVR. This patient was discovered to have a saddle pulmonary embolism for which thrombectomy was performed. The ST changes and tachycardia resolved after mechanical retrieval of the embolus.

References