Aortic stenosis electrocardiogram


 * Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [mailto:msbeih@perfuse.org]; ; Assistant Editor-In-Chief: Kristin Feeney, B.S. [mailto:kfeeney@perfuse.org]

Overview
The electrocardiogram in the patient with moderate to severe aortic stenosis may reveal left ventricular hypertrophy and heart block.

Electrocardiogram

 * Although there are no specific findings on the EKG, the presence of left ventricular hypertrophy (LVH) secondary to chronic pressure overload of the left ventricle due to aortic stenosis is commonly observed.


 * Progressive calcification of the aortic valve may extend beyond the valve and may result in conduction abnormalities of the heart including heart block.


 * Progressive concentric hypertrophy of the left ventricular wall may lead to larger QRS complexes, especially observed in leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a left ventricular strain pattern.

EKG Criteria for LVH

 * To diagnose left ventricular hypertrophy on the EKG one of the following criteria should be met:


 * Sokolow-Lyon criteria:
 * R in V5 or V6 + S in V1 >35 mm.


 * Other criteria:
 * R >26 mm in V5 or V6.
 * R >20 mm in I, II or III.
 * R >12 mm in aVL (in the absence of left anterior fascicular block).


 * Cornell-criteria has different values in men and women:
 * R in aVL and S in V3 >28 mm in men
 * R in aVL and S in V3 >20 mm in women


 * In the Romhilt-Estes Score,
 * LVH is likely with 4 or more points and
 * LVH is present with 5 or more points.