Electrocardiographic findings in left ventricular hypertrophy: Difference between revisions
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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}} | ||
{{SK}} LVH; LVH with strain; strain pattern | |||
==Overview== | ==Overview== | ||
Left ventricular hypertrophy is associated with increased [[QRS | 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== | ==Diagnosis== | ||
===Electrocardiography=== | |||
==== Sokolow and Lyon Criteria==== | |||
# 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. | # 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. | ||
# This criterion correlates well with the thickness of the LV walls and the diameter of the LV cavity as determined by ECHO. | # This criterion correlates well with the thickness of the LV walls and the diameter of the LV cavity as determined by ECHO. | ||
# Sensitivity 22% and specificity of 100%.<ref>Sokolow, M, and Lyon, T.P.: The Ventricular Complex As Obtained By Unipolar Limb Leads. Am. Heart J. 1949:37,161.</ref> | # Sensitivity 22% and specificity of 100%.<ref>Sokolow, M, and Lyon, T.P.: The Ventricular Complex As Obtained By Unipolar Limb Leads. Am. Heart J. 1949:37,161.</ref> | ||
===Effects of | ====Effects of Left Anterior Hemiblock on Diagnosing Acute myocardial infarction and Left Ventricular Hypertrophy==== | ||
[[Left anterior hemiblock|LAHB]] may be a cause of poor R wave progression across the precordium causing a pseudoinfarction pattern mimicking an [[Acute myocardial infarction|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 [[Left anterior hemiblock|LAHB]] you should see the presence of a “strain” pattern when you are relying on limb lead criteria to diagnose [[LVH]].<ref>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</ref> | [[Left anterior hemiblock|LAHB]] may be a cause of poor R wave progression across the precordium causing a pseudoinfarction pattern mimicking an [[Acute myocardial infarction|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 [[Left anterior hemiblock|LAHB]] you should see the presence of a “strain” pattern when you are relying on limb lead criteria to diagnose [[LVH]].<ref>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</ref> | ||
== Cornell Voltage Criteria == | ==== Cornell Voltage Criteria ==== | ||
# Add the height of the R wave in lead aVL to the depth of the S wave in lead V3. | # Add the height of the R wave in lead aVL to the depth of the S wave in lead V3. | ||
# LVH if the sum is > 28mm in men or > 20 mm in women. | # LVH if the sum is > 28mm in men or > 20 mm in women. | ||
# Sensitivity of 42% and specificity of 96%.<ref>Casale, P., Electrocardiographic detection of left ventricular hypertrophy: Development and prospective evaluation of improved criteria. J. Am. Coll Cardiol. 1985:6,572</ref> | # Sensitivity of 42% and specificity of 96%.<ref>Casale, P., Electrocardiographic detection of left ventricular hypertrophy: Development and prospective evaluation of improved criteria. J. Am. Coll Cardiol. 1985:6,572</ref> | ||
== Roberts Criteria == | ==== Roberts Criteria ==== | ||
# Add the QRS voltage in all 12 leads and [[LVH]] is present if the voltage exceeds 175 to 225 mm.<ref>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.</ref> | # Add the QRS voltage in all 12 leads and [[LVH]] is present if the voltage exceeds 175 to 225 mm.<ref>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.</ref> | ||
== Estes Criteria == | ==== Estes Criteria ==== | ||
# R or S in limb lead: 20 mm or more | # R or S in limb lead: 20 mm or more | ||
#* S in V1, V2, or V3: 25 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 | #* R in V4, V5, or V6: 25 mm or more | ||
# Any ST shift (without digitalis): 3 points | # Any ST shift (without digitalis): 3 points | ||
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4 points = probable [[LVH]]<ref>Surawicz, B.: Electrocardiographic diagnosis of chamber enlargement. J. Am. Coll. Cardiol. 1986: 8,711.</ref> | 4 points = probable [[LVH]]<ref>Surawicz, B.: Electrocardiographic diagnosis of chamber enlargement. J. Am. Coll. Cardiol. 1986: 8,711.</ref> | ||
== | ===Electrocardiographic Examples=== | ||
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== References == | |||
{{Reflist|2}} | |||
{{Electrocardiography}} | {{Electrocardiography}} | ||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
Latest revision as of 18:24, 17 October 2012
| Electrocardiographic findings in left ventricular hypertrophy | ||
 | ||
|---|---|---|
| eMedicine | med/ | |
| MeSH | [1] | |
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
- 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.
- This criterion correlates well with the thickness of the LV walls and the diameter of the LV cavity as determined by ECHO.
- 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
- Add the height of the R wave in lead aVL to the depth of the S wave in lead V3.
- LVH if the sum is > 28mm in men or > 20 mm in women.
- Sensitivity of 42% and specificity of 96%.[3]
Roberts Criteria
Estes Criteria
- 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
- Any ST shift (without digitalis): 3 points
- Typical "strain" ST T (with digitalis): 1 points
- LAD: 15 degrees or more: 2 points
- QRS interval: 0.09 seconds or more: 1 point
- Intrinsicoid deflection in V5 or V6 of 0.04 seconds or more: 1 point
- 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
-
Mechanism of left ventricular hypertrophy
-
-
Extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis
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LVH in subendocardial ischemia with positive cardiovascular markers
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LVH + Left Anterior Hemiblock
References
- ↑ Sokolow, M, and Lyon, T.P.: The Ventricular Complex As Obtained By Unipolar Limb Leads. Am. Heart J. 1949:37,161.
- ↑ 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
- ↑ Casale, P., Electrocardiographic detection of left ventricular hypertrophy: Development and prospective evaluation of improved criteria. J. Am. Coll Cardiol. 1985:6,572
- ↑ 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.
- ↑ Surawicz, B.: Electrocardiographic diagnosis of chamber enlargement. J. Am. Coll. Cardiol. 1986: 8,711.