Left ventricular hypertrophy electrocardiogram

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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

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

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:

• 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

For EKG examples of left ventricular hypertrophy click here.

References

1. 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
2. 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
3. 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
4. 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.CS1 maint: Multiple names: authors list (link)
5. Marriott, Henry J. L.; Wagner, Galen S. (2001). Marriott's practical electrocardiography. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0683307460.CS1 maint: Multiple names: authors list (link)
6. 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