RVH can be a normal finding in youngsters and in athletes. Attempts have been made to divide right ventricular patterns into volume and pressure abnormalities. Both have a vertical axis; pressure increases cause an R greater than S in V1-2 or an R wave greater than 7 mm in V1, and volume increases cause a loss of anterior forces and a counter-clockwise rotation with large terminal S waves laterally. RVH can be associated with COPD, primary and secondary pulmonary hypertension, pulmonary embolus and congenital heart disease.

Clinical correlation is indicated. If the RVH is new when comparing to previous tracings, consider the clinical presentation for pulmonary embolus (tachycardia, pleuritic chest pain, presence of cancer, immobilization) or exacerbation of lung disease. The patient may require hospitalization and treatment with heparin for PE or bronchodilators, antibiotics and steroids for COPD. If the pulmonary disease criteria are a stable finding, examine the patient for lung disease (prolonged expiration, hyperresonance, rhonchi and distant breath sounds, lowered diaphragms) and consider history and exposures including asbestos, coal dust and cigarette smoking. Pulmonary function testing may be indicated as well as an echocardiogram. Portable oxygen administration in hypoxic patients appears to decrease the pulmonary hypertension and improve their quality of life.