A marked right axis deviation greater than +110° suggests but is not diagnostic for right ventricular hypertrophy.
R and S Wave Voltages:
(1) R wave in V1 >= 7 mm
(2) S wave in V1 < 2 mm
(3) S wave in V5 or V6 >= 7 mm
(4) (R in V1) + (S in V5 or V6) > 10.5 mm in persons over 5 years of age
(5) R in V5 or V6 < 5 mm
(6) ratio of (R wave amplitude) / (S wave amplitude) in V5 or V6 is <= 1.0
(7) R wave in aVR >= 5 mm
(8) (R wave in V5) / (S wave in V5) divided by the (R wave in V1) / (S wave in V1) <= 0.4
(9) (R wave in V1) / (S wave in V1) > 4.0 in persons under the age of 5
(10) R wave in V1) / (S wave in V1) > 1.0 in persons over the age of 5
Other findings:
(1) delayed onset of the intrinsicoid deflection (delayed ventricular activation time) 0.04 to 0.07 seconds in V1 and/or V2.
(2) depression of the RS-T segment and inversion of the T wave in:
(a) V1 (and sometimes V2 or V3) when the R wave >= 5 mm
(b) aVL or aVF when the R wave >= 5 mm
where :
• 1 mm = 0.1 mV
The intrinsicoid deflection is the duration from the beginning of the earliest appearing Q or R wave to the peak of the R wave
(1) The end of the deflection represents the time of arrival of the electrical impulse at the epicardial surface located beneath the recording electrode.
(2) It is called intrinsic when the electrode is on the epicardial surface and intrinsicoid when the electrode is on the body surface.
(3) The intrinsicoid deflection for the right ventricle is measured in leads V1 and V2 and has an upper limit of 0.035 seconds.
(4) The intrinsicoid deflection for the left ventricle is measured in leads V5 and V6 and has an upper limit of 0.045 seconds.
(5) The intrinsicoid deflection may be increased either with ventricular hypertrophy or intraventricular conduction delay.
