Introduction
Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber.
While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and strength training, it is most frequently referred to as a pathological reaction to cardiovascular disease, or high blood pressure.
Such hypertrophy is usually the response to a chronic pressure or volume load.
The principal method to diagnose LVH is echocardiography, left ventricular wall is usually considered thickened when it is > 12mm; LVH is defined as an increase in left ventricular mass (LVM) > 115 g/m2 in men and > 95 g/m2 in women.
Etiology
- pressure overload states
- aortic stenosis
- systemic hypertension - hypertrophic cardiomyopathy
- physiologic changes associated with intense athletic training
- aortic or mitral valve regurgitation
ECG manifestation
Sokolow-Lyon index (specificity > 85%, sensitivity 20%)
- R wave in V5/V6 + S wave in V1/V2 > 35 mm
- R wave in aVL > 11 mm
Cornell voltage criteria
- men: S wave in V3 + R wave in aVL > 28 mm
- women: S wave in V3 + R wave in aVL > 20 mm
Modified Cornell criteria
- R wave in aVL > 12 mm
Other voltage criteria
- R wave in I + S wave in III > 25 mm
- R wave in aVF > 20 mm
- S wave in aVR > 14 mm
Precordial Leads
- R wave in V4, V5 or V6 > 26 mm
- largest R wave plus largest S wave in precordial leads > 45 mm
Non-voltage criteria
- increased R wave peak time > 50 ms in leads V5 or V6
- ST depression and T wave inversion in the left-sided leads
Romhilt-Estes LVH Point Score System
- If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.
Other ECG changes that may be seen in LVH
- left atrial enlargement
- left axis deviation
- ST elevation in the right precordial leads V1-3
- ST depression in left sided leads (V4-V6) with T wave inversion
ECG 1 Signs of LV hypertrophy
ECG 2 Positive modified Cornell criteria in a patient with HOCM after unsuccessful septal alcohol ablation (RBBB, LAH)
References
- Ary L Goldberger, David M Mirvis, Todd F Dardas. Left ventricular hypertrophy: Clinical findings and ECG diagnosis: https://www.uptodate.com/contents/left-ventricular-hypertrophy-clinical-findings-and-ecg-diagnosis
- https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/
- https://litfl.com/left-ventricular-hypertrophy-lvh-ecg-library/
Introduction
Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber.
While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and strength training, it is most frequently referred to as a pathological reaction to cardiovascular disease, or high blood pressure.
Such hypertrophy is usually the response to a chronic pressure or volume load.
The principal method to diagnose LVH is echocardiography, left ventricular wall is usually considered thickened when it is > 12mm; LVH is defined as an increase in left ventricular mass (LVM) > 115 g/m2 in men and > 95 g/m2 in women.
Etiology
- pressure overload states
- aortic stenosis
- systemic hypertension - hypertrophic cardiomyopathy
- physiologic changes associated with intense athletic training
- aortic or mitral valve regurgitation
ECG manifestation
Sokolow-Lyon index (specificity > 85%, sensitivity 20%)
- R wave in V5/V6 + S wave in V1/V2 > 35 mm
- R wave in aVL > 11 mm
Cornell voltage criteria
- men: S wave in V3 + R wave in aVL > 28 mm
- women: S wave in V3 + R wave in aVL > 20 mm
Modified Cornell criteria
- R wave in aVL > 12 mm
Other voltage criteria
- R wave in I + S wave in III > 25 mm
- R wave in aVF > 20 mm
- S wave in aVR > 14 mm
Precordial Leads
- R wave in V4, V5 or V6 > 26 mm
- largest R wave plus largest S wave in precordial leads > 45 mm
Non-voltage criteria
- increased R wave peak time > 50 ms in leads V5 or V6
- ST depression and T wave inversion in the left-sided leads
Romhilt-Estes LVH Point Score System
- If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.
Other ECG changes that may be seen in LVH
- left atrial enlargement
- left axis deviation
- ST elevation in the right precordial leads V1-3
- ST depression in left sided leads (V4-V6) with T wave inversion
ECG 1 Signs of LV hypertrophy
ECG 2 Positive modified Cornell criteria in a patient with HOCM after unsuccessful septal alcohol ablation (RBBB, LAH)
References
- Ary L Goldberger, David M Mirvis, Todd F Dardas. Left ventricular hypertrophy: Clinical findings and ECG diagnosis: https://www.uptodate.com/contents/left-ventricular-hypertrophy-clinical-findings-and-ecg-diagnosis
- https://ecgwaves.com/topic/ecg-left-ventricular-hypertrophy-lvh-clinical-characteristics/
- https://litfl.com/left-ventricular-hypertrophy-lvh-ecg-library/
