Right Ventricular Strain


= Repolarisation abnormality due to right ventricular hypertrophy or dilatation.

Electrocardiographic Features

ST depression and T wave inversion in the leads corresponding to the right ventricle, i.e

  • The right precordial leads:  V1-3, often extending out to V4
  • The inferior leads:  II, III, aVF, often most pronounced in lead III as this is the most rightward-facing lead.

NB. Compare this to the left ventricular strain pattern, where ST/T-wave changes are present in the left ventricular leads (I, aVL, V5-6).


Associated with increased pulmonary artery pressures in the setting of acute or chronic right ventricular hypertrophy or dilatation:

ECG Examples

Example 1 – Right ventricular hypertrophy 

  • Typical right ventricular strain pattern: ST depression and T-wave inversion in V1-4 (plus lead III), in this case due to right ventricular hypertrophy.


Example 2 – Acute right ventricular dilatation due to massive PE

  • Right ventricular strain pattern involving both the precordial and inferior leads:  T-wave inversions are seen in the right precordial (V1-4) and inferior leads (III, aVF) in this patient with acute right ventricular dilatation due to massive pulmonary embolism.


Related Topics

For more great examples of right heart strain check out these ECG library pages:

Further Reading

Author Credits


  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
  • Harrigan RA, Jones K. ABC of clinical electrocardiography. Conditions affecting the right side of the heart. BMJ. 2002 May 18;324(7347):1201-4. Review. PMID: 12016190. Full text.
  • Mattu A, Brady W. ECGs for the Emergency Physician 1, BMJ Books 2003.
  • Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.
  • Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice (6th edition), Saunders 2008.
  • Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
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  1. ted burningham says

    in boston on vacation and just thought I’d learn a little bit more about right ventricular strain pattern changes on ecg. LOVED IT!!! quick , accurate and easy… all good comments of an excellent teacher.