Left ventricular hypertrophy: Difference between revisions
 
(15 intermediate revisions by 5 users not shown)
Line 1: Line 1:
==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


Line 9: Line 13:
#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===
Line 21: Line 24:


*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'''
===Common Causes===
*[[Hypertension (Main)]]
*[[Aortic Stenosis]]
*[[Aortic Regurgitation]]
*[[Coarctation of the Aorta]]
*[[Hypertrophic Cardiomyopathy]]
*[[Mitral Regurgitation]]


===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
|-
|-
Line 59: Line 55:
||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)]]


== Source ==
==References==
*Adapted from lecture by Dr. James Niemann MD, Lampe, Pani, Donaldson, ECGpedia.org
*Journal of Electrocardiology. Vol 43 (2010). 40-42.
<references/>
<references/>


[[Category:Cards]]
[[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]

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.
LVH.png
  • Most commonly used criteria
  1. R in V5 or V6 + S in V1 >35 mm.

Cornell Criteria

  1. R in aVL and S in V3 >28 mm in men
  2. 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):
  1. R or S in limb leads ≥20 mm
  2. S in V1 or V2 ≥30 mm
  3. 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

See Also

References

  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
Retrieved from "https://www.wikem.org/w/index.php?title=Left_ventricular_hypertrophy&oldid=197094"