Left ventricular hypertrophy electrocardiogram: Difference between revisions

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__NOTOC__
{{LVH}}
{{LVH}}
{{CMG}}
{{CMG}}


==Overview==
==Overview==
The [[electrocardiogram]] (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.
The [[electrocardiogram]] (EKG) often shows signs of increased voltage from the heart in individuals with left ventricular hypertrophy, so this is often used as a screening test to determine who should undergo further testing with an [[echocardiogram]].


==Electrocardiogram Criteria for Diagnosing LVH==
==Electrocardiogram==
 
===Electrocardiogram Criteria for Diagnosing LVH===


There are multiple criteria used to diagnose LVH via electrocardiography. None of them are perfect. However, by using multiple different criteria the [[sensitivity (tests)|sensitivity]] and [[Specificity (tests) | specificity]] are increased.
There are multiple criteria used to diagnose LVH via electrocardiography. None of them are perfect. However, by using multiple different criteria the [[sensitivity (tests)|sensitivity]] and [[Specificity (tests) | specificity]] are increased.


The Sokolow and Lyon criteria
The Sokolow and Lyon criteria
*S in V1 + R in V5 or V6 (whichever is larger) =/> 35 mm
*S in [[Electrocardiogram#Precordial|V1]] + R in [[Electrocardiogram#Precordial|V5]] or [[Electrocardiogram#Precordial|V6]] (whichever is larger) ≥ 35 mm
*R in aVL =/> 11 mm
*R in [[Electrocardiogram#Augmented limb|aVL]] ≥ 11 mm


The Cornell criteria<sup>1</sup> for the ECG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead V<sub>3</sub>.  The Cornell criteria for LVH are:
The Cornell criteria<sup>1</sup> for the EKG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead [[Electrocardiogram#Precordial|V3]].  The Cornell criteria for LVH are:
*S in V<sub>3</sub> + R in aVL > 28 mm (men)
*S in [[Electrocardiogram#Precordial|V3]] + R in [[Electrocardiogram#Augmented limb|aVL]] > 28 mm (men)
*S in V<sub>3</sub> + R in aVL > 20 mm (women)
*S in [[Electrocardiogram#Precordial|V3]] + R in [[Electrocardiogram#Augmented limb|aVL]] > 20 mm (women)


Other voltage-based criteria for LVH include:
Other voltage-based criteria for LVH include:


*Lead I: R wave > 14 mm
*Lead [[Electrocardiogram#Limb|I]]: R wave > 14 mm
*Lead aVR: S wave > 15 mm
*Lead [[Electrocardiogram#Augmented limb|aVR]]: S wave > 15 mm
*Lead aVL: R wave > 12 mm
*Lead [[Electrocardiogram#Augmented limb|aVL]]: R wave > 12 mm
*Lead aVF: R wave > 21 mm
*Lead [[Electrocardiogram#Augmented limb|aVF]]: R wave > 21 mm
 
*Lead [[Electrocardiogram#Precordial|V5]]: R wave > 26 mm
*Lead [[Electrocardiogram#Precordial|V6]]: R wave > 20 mm
 
===EKG Examples===
Shown below is an EKG with an [[R wave]] in lead [[Electrocardiogram#Precordial|V5]] (26mm) and an [[S wave]] in lead [[Electrocardiogram#Precordial|V1]] (15mm). The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.


*Lead V<sub>5</sub>: R wave > 26 mm
[[Image:Left ventricular hypertrophy1.jpg|center|500px]]
*Lead V<sub>6</sub>: R wave > 20 mm
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:E_lvh.jpg
----
Shown below is an EKG with an [[S wave]] in lead [[Electrocardiogram#Precordial|V1]] (24mm) and an [[R wave]] in lead [[Electrocardiogram#Precordial|V6]] (21mm). The sum is 45mm which is more than 35mm depicting left ventricular hypertrophy. The EKG also shows an R wave in lead [[Electrocardiogram#Augmented limb|aVL]] (23mm) which is more than 11mm. Thus, both conditions in Sokolow and Lyon criteria are fulfilled.


[[Image:LVH 3.jpg|center|500px]]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh2.jpg
----
Shown below is an EKG with an [[R wave]] in lead [[Electrocardiogram#Limb|I]] (17mm) which is greater than 14mm. The [[S wave]] in lead [[Electrocardiogram#Precordial|V1]] is 21 mm and R wave in lead [[Electrocardiogram#Precordial|V5]] and/or [[Electrocardiogram#Precordial|V6]] is around 24 mm. The sum is 45mm which is more than 35mm and thus left ventricular hypertrophy is present according to Sokolow-Lyon criteria.


<gallery>
[[Image:LVH05.jpg|center|500px]]
Image:E_lvh.jpg|LVH: R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:LVH.png
Image:LVH.jpg|ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria
----
Image:Extreme_lvh2.jpg|Another example of extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis
Shown below is an EKG with an [[S wave]] in lead [[Electrocardiogram#Precordial|V1]] (25mm) and an [[R wave]] in lead [[Electrocardiogram#Precordial|V6]] (17mm). The sum is 42mm which is more than 35mm and therefore LVH is present according to Sokolow-Lyon criteria.
</gallery>
[[Image:LVH 4.jpg|center|800px]]
Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh.jpg


'''For more EKG examples of left ventricular hypertrophy click [[Left ventricular hypertrophy EKG examples|here]].'''


<gallery>
----
Image:extreme_lvh.jpg|ECG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing
Image:LVH.png
</gallery>


==References==
==References==
{{refbegin|2}}
{{reflist|2}}
#Sokolow Sokolow M, Lyon TP: ''The ventricular complex in left verntricular hypterfophy as obtained by unipolar precordial and limb leads.'' Am Heart J 37: 161, 1949
[[Category:Best pages]]
#Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men Circulation. 2001 May 15;103(19):2346-51. PMID 11352882
[[Category:Electrophysiology]]
#Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB.Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994 Oct;90(4):1786-93.Related Articles, Links PMID 7923663
[[Category:Cardiology]]
#{{cite journal |author=Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P |title=Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings |journal=Circulation |volume=75 |issue=3 |pages=565-72 |year=1987 |pmid=2949887 |doi=}}
{{WH}}
#{{cite book |author=Marriott, Henry J. L.; Wagner, Galen S. |title=Marriott's practical electrocardiography |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2001 |pages= |isbn=0683307460 |oclc= |doi=}}
{{WS}}
#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
{{refend}}

Latest revision as of 18:18, 14 January 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The electrocardiogram (EKG) often shows signs of increased voltage from the heart in individuals with left ventricular hypertrophy, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.

Electrocardiogram

Electrocardiogram Criteria for Diagnosing LVH

There are multiple criteria used to diagnose LVH via electrocardiography. None of them are perfect. However, by using multiple different criteria the sensitivity and specificity are increased.

The Sokolow and Lyon criteria

  • S in V1 + R in V5 or V6 (whichever is larger) ≥ 35 mm
  • R in aVL ≥ 11 mm

The Cornell criteria1 for the EKG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead V3. The Cornell criteria for LVH are:

  • S in V3 + R in aVL > 28 mm (men)
  • S in V3 + R in aVL > 20 mm (women)

Other voltage-based criteria for LVH include:

  • Lead I: R wave > 14 mm
  • Lead aVR: S wave > 15 mm
  • Lead aVL: R wave > 12 mm
  • Lead aVF: R wave > 21 mm
  • Lead V5: R wave > 26 mm
  • Lead V6: R wave > 20 mm

EKG Examples

Shown below is an EKG with an R wave in lead V5 (26mm) and an S wave in lead V1 (15mm). The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:E_lvh.jpg

Shown below is an EKG with an S wave in lead V1 (24mm) and an R wave in lead V6 (21mm). The sum is 45mm which is more than 35mm depicting left ventricular hypertrophy. The EKG also shows an R wave in lead aVL (23mm) which is more than 11mm. Thus, both conditions in Sokolow and Lyon criteria are fulfilled.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh2.jpg

Shown below is an EKG with an R wave in lead I (17mm) which is greater than 14mm. The S wave in lead V1 is 21 mm and R wave in lead V5 and/or V6 is around 24 mm. The sum is 45mm which is more than 35mm and thus left ventricular hypertrophy is present according to Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:LVH.png

Shown below is an EKG with an S wave in lead V1 (25mm) and an R wave in lead V6 (17mm). The sum is 42mm which is more than 35mm and therefore LVH is present according to Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh.jpg

For more EKG examples of left ventricular hypertrophy click here.

References

Template:WH Template:WS

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