In cases of right ventricular hypertrophy, how does the R wave typically change from V1 to V4?

In cases of right ventricular hypertrophy, how does the R wave typically change from V1 to V4?

• A. It becomes progressively larger
• B. It remains constant
• C. It becomes progressively smaller
• D. It becomes biphasic

Answer: (C)

In cases of right ventricular hypertrophy (RVH), one of the key EKG findings is the change in the amplitude of the R wave as you move from lead V1 to lead V4. Specifically, as RVH develops, the R wave in lead V1 tends to become larger due to the increased muscle mass of the right ventricle, which generates more electrical activity in this region. However, as you move to V4, the R wave typically decreases in amplitude. This phenomenon is referred to as the "R wave progression."

The decrease in R wave amplitude from V1 to V4 is indicative of the right ventricular hypertophy's effect on the overall electrical vectors in the heart. Therefore, the correct answer accurately reflects that while there might be an initial increase in V1, the expected change from V1 to V4 is indeed a progressive decrease in the amplitude. This understanding is crucial for interpreting EKGs and identifying RVH effectively.