Left ventricular hypertrophy

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

Authors:

Ross Donaldson