Aortic stenosis electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Mohammed A. Sbeih, M.D. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]; Assistant Editor-In-Chief: Kristin Feeney, B.S. [4]

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 .

Examples of EKG Findings in patients with AS

Left Ventricular Hypertrophy

LVH-ECG

Severe LVH in a patient with Severe Aortic Stenosis

Example of severe left ventricular hypertrophy in a patient with severe aortic valve stenosis.

Example of severe left ventricular hypertrophy in a patient with severe aortic valve stenosis.

Patient with LVH and Subendocardial Ischemia

EKG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.

LVH & Left Ventricular Strain Pattern

Left ventricular hypertrophy; left ventricular strain due to aortic stenosis.