Left ventricular hypertrophy electrocardiogram: Difference between revisions
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The Sokolow and Lyon criteria | The Sokolow and Lyon criteria | ||
*S in [[Electrocardiogram#Precordial|V1]] + R in [[Electrocardiogram#Precordial|V5]] or [[Electrocardiogram#Precordial|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 [[Electrocardiogram#Precordial|V3]]. The Cornell criteria for LVH are: | 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 [[Electrocardiogram#Precordial|V3]]. The Cornell criteria for LVH are: | ||
*S in [[Electrocardiogram#Precordial|V3]] + R in aVL > 28 mm (men) | *S in [[Electrocardiogram#Precordial|V3]] + R in [[Electrocardiogram#Augmented limb|aVL]] > 28 mm (men) | ||
*S in [[Electrocardiogram#Precordial|V3]] + 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|V5]]: R wave > 26 mm | ||
Revision as of 19:29, 22 October 2012
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Left ventricular hypertrophy Microchapters |
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Differentiating Left ventricular hypertrophy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Left ventricular hypertrophy On the Web |
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American Roentgen Ray Society Images of Left ventricular hypertrophy |
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Directions to Hospitals Treating Left ventricular hypertrophy |
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Risk calculators and risk factors for Left ventricular hypertrophy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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.
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
The Cornell criteria1 for the ECG 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:
Other voltage-based criteria for LVH include:
EKG Examples
The EKG below shows 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
The EKG below shows 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
The EKG below shows 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
For more EKG examples of left ventricular hypertrophy click here.
References
- 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
- 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
- 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
- Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987). "Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings". Circulation. 75 (3): 565–72. PMID 2949887.
- Marriott, Henry J. L.; Wagner, Galen S. (2001). Marriott's practical electrocardiography. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0683307460.
- 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