ECG signs of RV strain are

  Negative T waves in leads V1 to V4.

  Negative T waves in leads III and aVF.

  Right axis deviation ( > +90 degrees )

  S1Q3T3 pattern:

                  S wave in lead I

                  Q wave in lead III

                  T wave inversion in lead III

  Complete or incomplete right bundle branch block.

  Right atrial abnormality.




Clinical significance

  In patients with acute pulmonary embolism, observation of RV strain pattern on ECG shows

      ominous prognosis.




Reference

  Am J Med 2009;122:257-264.





ECG 1. The ECG above belongs to an 82 years-old woman with long-standing chronic obstructive pulmonary disease (COPD).
She has no known coronary artery disease and has not undergone coronary angiography before. She complained of dyspnea.
The echocardiogram showed massive dilation of the right ventricle and right atrium (RV size was 2-3 times that of the LV);
normal LV systolic function and leftward deviation of the interventricular septum
Her ECG shows signs of right ventricular strain: negative T waves in right precordial leads, S1Q3T3 pattern,
right axis deviation, and negative T waves in leads III and aVF.

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