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Electrocardiographic findings in left ventricular hypertrophy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Synonyms and keywords: LVH; LVH with strain; strain pattern

Overview

Left ventricular hypertrophy is associated with increased QRS voltage on the EKG and a strain pattern or inverted checkmark pattern to the T wave in the lateral leads. There are a variety of criteria used to diagnose left ventricular hypertrophy (LVH) on the EKG.

Diagnosis

Electrocardiography

Sokolow and Lyon Criteria

  1. Add the depth of the S wave in V1 to the height of the R wave in lead V5 or V6 (whichever is taller) and if the sum is greater than 35 mm then LVH is present.
  2. This criterion correlates well with the thickness of the LV walls and the diameter of the LV cavity as determined by ECHO.
  3. Sensitivity 22% and specificity of 100%.[1]

Effects of Left Anterior Hemiblock on Diagnosing Acute myocardial infarction and Left Ventricular Hypertrophy

LAHB may be a cause of poor R wave progression across the precordium causing a pseudoinfarction pattern mimicking an anteroseptal infarction. It also makes the electrocardiographic diagnosis of LVH more complicated, because both may cause a large R wave in lead aVL. Therefore to call LVH on an EKG in the setting of an LAHB you should see the presence of a “strain” pattern when you are relying on limb lead criteria to diagnose LVH.[2]

Cornell Voltage Criteria

  1. Add the height of the R wave in lead aVL to the depth of the S wave in lead V3.
  2. LVH if the sum is > 28mm in men or > 20 mm in women.
  3. Sensitivity of 42% and specificity of 96%.[3]

Roberts Criteria

  1. Add the QRS voltage in all 12 leads and LVH is present if the voltage exceeds 175 to 225 mm.[4]

Estes Criteria

  1. R or S in limb lead: 20 mm or more
    • S in V1, V2, or V3: 25 mm or more 3 points
    • R in V4, V5, or V6: 25 mm or more
  2. Any ST shift (without digitalis): 3 points
    • Typical “strain” ST T (with digitalis): 1 points
  3. LAD: 15 degrees or more: 2 points
  4. QRS interval: 0.09 seconds or more: 1 point
  5. Intrinsicoid deflection in V5 or V6 of 0.04 seconds or more: 1 point
  6. P terminal force in V1 more than 0.04 sec: 1 point

Total possible: 13 points

Total of 5 points = LVH, 4 points = probable LVH[5]

Electrocardiographic Examples

References

  1. ↑ Sokolow, M, and Lyon, T.P.: The Ventricular Complex As Obtained By Unipolar Limb Leads. Am. Heart J. 1949:37,161.
  2. ↑ Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5
  3. ↑ Casale, P., Electrocardiographic detection of left ventricular hypertrophy: Development and prospective evaluation of improved criteria. J. Am. Coll Cardiol. 1985:6,572
  4. ↑ Roberts, W. and Podalak, M: The king of hearts: Analysis of 23 patients with hearts weighing 1,000 grams or more. Am J. Cardiol. 1985:55,485.
  5. ↑ Surawicz, B.: Electrocardiographic diagnosis of chamber enlargement. J. Am. Coll. Cardiol. 1986: 8,711.


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