Left ventricular hypertrophy: Difference between revisions
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==ECG Findings== | ==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<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>=== | ===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>=== | ||
[[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 | *Most commonly used criteria | ||
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#R in aVL and S in V3 >28 mm in men | #R in aVL and S in V3 >28 mm in men | ||
#R in aVL and S in V3 >20 mm in women | #R in aVL and S in V3 >20 mm in women | ||
===Other Voltage Based Criteria=== | ===Other Voltage Based Criteria=== | ||
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*V4-V6 precordial leads may show ST depression & T wave inversions known as the '''LV Strain pattern''' | *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>=== | ===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" | {| class="wikitable" | ||
||'''ECG Criteria'''||'''Points''' | ||'''ECG Criteria'''||'''Points''' | ||
|- | |- | ||
||Voltage Criteria (any of): | ||Voltage Criteria (any of): | ||
# R or S in limb leads ≥20 mm | #R or S in limb leads ≥20 mm | ||
# S in V<sub>1</sub> or V<sub>2</sub> ≥30 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 | #R in V<sub>5</sub> or V<sub>6</sub> ≥30 mm | ||
||3 | ||3 | ||
|- | |- | ||
||ST-T Abnormalities: | ||ST-T Abnormalities: | ||
* ST-T vector opposite to QRS without digitalis | *ST-T vector opposite to QRS without digitalis | ||
* ST-T vector opposite to QRS with digitalis | *ST-T vector opposite to QRS with digitalis | ||
|| | || | ||
3 | 3<br> | ||
1 | 1 | ||
|- | |- | ||
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||1 | ||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== | ==See Also== | ||
*[[ECG (Main)]] | *[[ECG (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Cardiology]] |
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]
- 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):
|
3 |
ST-T Abnormalities:
|
3 |
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
- Hypertension (Main)
- Aortic Stenosis
- Aortic Regurgitation
- Coarctation of the Aorta
- Hypertrophic Cardiomyopathy
- Mitral Regurgitation
- Infiltrative Cardiac Processes
Differential Diagnosis
Cardiac Hypertrophy and Enlargement
- Right atrial enlargement
- Left atrial enlargement
- Left ventricular hypertrophy
- Right ventricular hypertrophy
See Also
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