Electrocardiographic assessment of right heart dysfunction
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Updated: Oct 17, 2026

Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Abstract:
The electrocardiogram, when used in light of other clinical data, can be a powerful tool in detecting right heart dysfunction. Right bundle branch block can be identified on the electrocardiogram by the presence of an RSR' configuration in right-sided chest leads. Right atrial enlargement produces tall pointed P waves in lead II and biphasic P waves in V1, whose initial upstroke is larger than the terminal downstroke. Right ventricular enlargement is best seen on the electrocardiogram by a reverse in the pattern of normal R wave progression across the precordium. Occurring most often with an inferior wall myocardial infarction, a right ventricular infarction is depicted by ST segment elevations in right-sided precordial leads. The ability to detect these electrocardiographic changes will enhance the nurse's assessment and management of patients with right heart dysfunctions.
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