Right ventricular hypertrophy.

The electrocardiograms of 22 cases showing isolated right ventricular hypertrophy at autopsy were examined for changes suggestive of right ventricular hypertrophy. Only 5 of 22 cases fulfilled at least one of the criteria of Sokolow and Lyon and only three could be diagnosed as having right ventricular hypertrophy by the criteria of Myers, Klein and Stofer. Factors contributing to the development of electrocardiographic changes of right ventricular hypertrophy are discussed. HE DIAGNOSIS of enlargment of the right ventricle is difficult notwithstanding the use of all available methods of study. The teleoroentgenogram of the chest is relatively unreliable. In a study of 39 cases of cor pulmonale proved by autopsy, Zimmerman and Ryan' found x-ray evidence of a large pulmonary artery segment or right ventricular enlargement in only six instances. Spain and Handler2 stated only "a few" of the 60 cases of cor pulmonale which they examined at autopsy had shown radiologic evidence of right ventricular hypertrophy. Sussman, Grish-man and Steinberg3 studied 28 cases of emphy-sema radiographically and found no heart greater than the predicted size on the posterio-anterior view. By angiocardiograms 12 of these cases presented right ventricular dilatation and an additional 12 cases showed questionable dilatation. Several papers have been published concerning the reliability of the electrocardiogram in the diagnosis of right ventricular hyper-trophy.4-9 Berlinger and Master7 using the standard limb leads correlated the autopsy and electrocardiographic findings in mitral stenosis. The electrocardiogram demonstrated right ventricular preponderance in 40 of 45 cases and a "trend" to right ventricular preponderance in 11 of 12 cases. Katz and his co-workers8 found positive electrocardiographic findings in seven of eight cases of anatomically demonstrated right ventricular preponderance. In autopsy studies of cor pulmonale Spain and Handler,2 and Zimmerman and Ryan' reported the presence of right axis deviation in 14 of 21, and 23 of 43 cases, respectively. More recently several studies have been reported using the unipolar limb and precordial leads. Levine and Phillips5 found electrocardio-graphic evidence of right ventricular hyper-trophy in 8 of 10 autopsy-proven cases of right ventricular hypertrophy. Myers, Klein and Stofer4 reported 40 autopsied cases of anatomic right ventricular preponderance. Thirty-three of these showed either the electrocardiographic pattern of right ventricular hypertrophy or right bundle-branch block. Sokolow and Lyon6 set up criteria for the electrocardio-graphic diagnosis of right ventricular hyper-trophy from 60 cases. Only six of these were proven by autopsy. The diagnosis was established at surgery in 20 …