Right Ventricular Hypertrophy

[JStoner]

My 18-year-old son had a physical for the volunteer fire department.  His ECG came back abnormal with this:
Vent. Rate 76 bpm
PR Interval:  782 ms
PR Interval: 168 ms
QRS duration: 102 ms
QT interval: 374 ms
QT Interval: 374 ms
QTc Interval: 402 ms
QT Dispersion: 38 ms
P-R-T AXIS: 63  108  50
sinus arrhythmia
rightward axis
incomplete RBBB
Right ventricular hypertrophy
He will have an echo tomorrow AM.  He will be going out of town for 6 weeks and won't be able to see a cardiologist until he gets back.  His GP was making out like it was normal and nothing to worry about, but everything I've seen online says the opposite!!  I'm trying not to be the over-protective mother but am concerned and don't want to just dismiss it if I shouldn't.  Is it a big deal or not??

[chinnarisruthi]

my husband is 34 years old recently suffered from indigestion gastric problem and non specific cardiac pain but when we took an ecg the computer report was right ventricular hypertrophy,rate is 71,pr is 173,QRSD  is 92,QT is 333,QTc is 362. axis P-28,QRS -109,T-33.we are going to 2d echo tomm but iam very much worried about the ECG .can we rely on just computer ecg report sir??

[is_something_wrong]

* I agree (as I often DO)  - sorry for bad English :)

[is_something_wrong]

I didn't think it was possible to develop RVH (or LVH) at the age of 18. It's usually caused by high blood pressure (in this case in the pulmonary arteries) for a long time. Diagnosis is made by the EKG machine by higher "spikes" in the leads placed over right ventricle. Higher spikes can be caused by misplaced electrodes, higher adrenaline levels (as cardiac cells fire "harder") being young, athletic, etc.

iRBBB often causes a right axis deviation. iRBBB and RBBB is often not caused by heart disease, LBBB on the other hand, usually is.

I agree (as I often does) with Itdood, doing the echocardiography is a good idea, just to be sure nothing is wrong.

I think Brugada syndrome manifests with very specific EKG changes (including shortened QT time, and the QT time is completely normal), and it's extremely rare. ARVC / ARVD would probably create a LOT of PVCs and often specific changes in the EKG.

[kcd86]

A RBBB rarely occurs in an otherwise normal heart!
Some cardiac conditions that can cause RBBB include,
Heart rate related(functional RBBB)
Cor Pulmonale-pulmonary hypertension from various lung issues- not sudden onset
Myocardial ischemia, infarction, or inflammation-myocarditis
Hypertension, cardiomyopathies and
Congential abnormalities:  THESE NEED TO BE RULED OUT by a specialist an Electreophysiologist
            Brugada syndrome have a RBBB pattern
            Arrhythmogenic right ventricular cardiomyopathy
Patients with isolated chronic RBBB are generally asymptomatic and do not require any intervention but warrants a complete cardiac work-up
An echocardiogram is the first test to help diagnose/eliminate any potential serious underlying issues.
Good Luck

[r9c]

I think if ecgs shows LVH or RVH it should be further confirmed by a cardiologist,on an echo which they can measure the wall thickness and pumping abilities.ECG are not very reliable in predicting wall thickness and heart enlargement as they just calculate by timings and electrical activities unlike an echo which can see through those valves and measure it.

[grendslori]

Your son needs to be seen by a good cardiologist who knows how to deal with hypertrophic cardiomyopaties. It is true that a right hypertrophy isn't as important as a left ventricular hypertrophy, the reason being that the left ventricle is the main pumping chamber of the heart. The EKG can be misleading, but if the complexes have MAJOR differences in the way they look, you can bet there is something not right. My daughter's complexes literally shot off of the page and even run on a half standard were too tall to read. Your son needs to be seen.  

[itdood]

Sinus Arrhythmia is completely normal.  This is when we breathe in the heart speeds up.  When we exhale it slows down.  It makes gas exchange more efficient.  The heart moves more blood through the lungs as fresh air comes in.  The heart slows down during exhale so blood doesn't just pass through without getting some of that fresh air.

The rightward axis and iRBBB might be related.    The rightward axis and iRBBB are both electrical / conduction findings.    Both of these can be false-positive results.

The hypertrophy in the right ventricle means the muscle is thicker than normal.  The EKG computer is guessing based on what it is seeing with electrical timings and measurements.    In other words, the EKG thinks it saw rightward axis and iRBBB.  The computer is programmed to suggest that with those two coming up, evaluate further for Right Ventricular hypertrophy.

So, get the echo.  Chances are everything is cool.

I don't trust EKGs with soft findings like that, they notoriously throw false - positives.  Worse, I've even heard of false - negatives meaning that it said everything was cool but wasn't.  

You're doing the right thing to follow and get the echo.  Probably nothing but best to get checked out.

[Jerry_NJ]

Too much detail for my minimal expertise, but I'd go with the doctor.  While your son does need to be examined by a cardiologist, I'd offer comfort in my belief that GP doctors know a good bit about heart problems and associated risks.  There's no reason form him to "under estimate" the severity.  Indeed, some of  the high cost of medicine comes from overprotective actions by the medical professional, to help guard them against law suits.