Left ventricular hypertrophy: Difference between revisions

Latest revision as of 01:31, 22 October 2018

ECG Findings

Common to have TWI in I and aVL but should be in both
If only aVL, very likely reciprocal change at the start of inf MI

Sokolow-Lyon criterium^[1]

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.

Most commonly used criteria

R in V5 or V6 + S in V1 >35 mm.

Cornell Criteria

R in aVL and S in V3 >28 mm in men
R in aVL and S in V3 >20 mm in women

Other Voltage Based Criteria

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

V4-V6 precordial leads may show ST depression & T wave inversions known as the LV Strain pattern

Romhilt-Estes Criteria^[2]

Diagnostic ≥ 5 points and probable ≥ 4 points)

ECG Criteria	Points
Voltage Criteria (any of): R or S in limb leads ≥20 mm S in V₁ or V₂ ≥30 mm R in V₅ or V₆ ≥30 mm	3
ST-T Abnormalities: ST-T vector opposite to QRS without digitalis ST-T vector opposite to QRS with digitalis	3 1
Negative terminal P mode in V₁ 1 mm in depth and 0.04 sec in duration (indicates left atrial enlargement)	3
Left axis deviation (QRS of -30° or more)	2
QRS duration ≥0.09 sec	1
Delayed intrinsicoid deflection in V₅ or V₆ (>0.05 sec)	1

Common Causes

Differential Diagnosis

Cardiac Hypertrophy and Enlargement

References

↑ Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37: 161, 1949
↑ Romhilt DW and Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 1968 Jun; 75(6) 752-8. lmid:4231231

Authors:

[1] Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37: 161, 1949

[2] Romhilt DW and Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 1968 Jun; 75(6) 752-8. lmid:4231231

[1]

[2]

@@ Line 1: / Line 1: @@
-#Sum of S in V1 or V2 & R in V5 or V6 is >35mm
+==ECG Findings==
-#Sum of highest R & deepest S in precord is >45mm
+*Common to have TWI in I and aVL but should be in both
-#R wave in V6 > 18mm
+*If only aVL, very likely reciprocal change at the start of inf MI
-#R in AVL of >12mm
-#L precordial leads may show ST depression & TWI = LV strain pattern
+===Sokolow-Lyon criterium<ref>Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 37: 161, 1949</ref>===
-#LAD-with slightly wide QRS. Or r in avl greater than 11mm, r in 1 is greater than 12mm, or R in AVf is greater than 20mm
+[[File:E lvh.jpg|thumb|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.]]
+[[File:LVH.png|thumb|]]
+*Most commonly used criteria
+#R in V5 or V6 + S in V1 >35 mm.
+===Cornell Criteria===
+#R in aVL and S in V3 >28 mm in men
+#R in aVL and S in V3 >20 mm in women
+===Other Voltage Based Criteria===
+*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 V<sub>5</sub>: R wave > 26&nbsp;mm
+*Lead V<sub>6</sub>: R wave > 20&nbsp;mm
+*V4-V6 precordial leads may show ST depression & T wave inversions known as the '''LV Strain pattern'''
+===Romhilt-Estes Criteria<ref>Romhilt DW and Estes EH Jr. A point-score system for the ECG diagnosis of left ventricular hypertrophy. Am Heart J 1968 Jun; 75(6) 752-8. lmid:4231231</ref>===
+Diagnostic  ≥ 5 points and probable ≥ 4 points)
+{| class="wikitable"
+||'''ECG Criteria'''||'''Points'''
+|-
+||Voltage Criteria (any of):
+#R or S in limb leads ≥20 mm
+#S in V<sub>1</sub> or V<sub>2</sub> ≥30 mm
+#R in V<sub>5</sub> or V<sub>6</sub> ≥30 mm
+||3
+|-
+||ST-T Abnormalities:
+*ST-T vector opposite to QRS without digitalis
+*ST-T vector opposite to QRS with digitalis
+||
+<br>
+|-
+||Negative terminal P mode in V<sub>1</sub> 1&nbsp;mm in depth and 0.04 sec in duration (indicates left atrial enlargement)
+||3
+|-
+||Left axis deviation (QRS of -30° or more)
+||2
+|-
+||QRS duration ≥0.09 sec
+||1
+|-
+||Delayed intrinsicoid deflection in V<sub>5</sub> or V<sub>6</sub> (>0.05 sec)
+||1
+|}
+==Common Causes==
+*[[Hypertension (Main)]]
+*[[Aortic Stenosis]]
+*[[Aortic Regurgitation]]
+*[[Coarctation of the Aorta]]
+*[[Hypertrophic Cardiomyopathy]]
+*[[Mitral Regurgitation]]
+*Infiltrative Cardiac Processes
+**[[Amyloidosis]]
+**[[Sarcoidosis]]
+**[[Hemochromatosis]]
+==Differential Diagnosis==
+{{Cardiac hypertrophy DDX}}
 ==See Also==
-*[[ECG (Basics)]]
+*[[ECG (Main)]]
-== Source ==
+==References==
-*Adapted from Niemann, Lampe, Pani, Donaldson, ECGpedia.org
+<references/>
-*Journal of Electrocardiology. Vol 43 (2010). 40-42.
-[[Category:Cards]]
+[[Category:Cardiology]]