Electrocardiographic findings in left ventricular hypertrophy


 * Associate Editor-In-Chief:

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.

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%.

Effects of LAHB 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.

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%.

Roberts Criteria

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

Estes Criteria

 * 1) R or S in limb lead: 20 mm or more
 * 2) * S in V1, V2, or V3: 25 mm or more              3 points
 * 3) * R in V4, V5, or V6: 25 mm or more
 * 4) Any ST shift (without digitalis): 3 points
 * 5) * Typical "strain" ST T (with digitalis): 1 points
 * 6) LAD: 15 degrees or more: 2 points
 * 7) QRS interval: 0.09 seconds or more: 1 point
 * 8) Intrinsicoid deflection in V5 or V6 of 0.04 seconds or more: 1 point
 * 9) 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