Left ventricular hypertrophy electrocardiogram: Difference between revisions

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Latest revision as of 18:18, 14 January 2013

Left ventricular hypertrophy Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Left ventricular hypertrophy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

CT

MRI

Echocardiography

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Left ventricular hypertrophy On the Web

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Most cited articles

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American Roentgen Ray Society Images of Left ventricular hypertrophy

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

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Left ventricular hypertrophy in the news

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Directions to Hospitals Treating Left ventricular hypertrophy

Risk calculators and risk factors for Left ventricular hypertrophy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The electrocardiogram (EKG) often shows signs of increased voltage from the heart in individuals with left ventricular hypertrophy, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.

Electrocardiogram

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 EKG 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

EKG Examples

Shown below is an EKG with an R wave in lead V5 (26mm) and an S wave in lead V1 (15mm). The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:E_lvh.jpg


Shown below is an EKG with an S wave in lead V1 (24mm) and an R wave in lead V6 (21mm). The sum is 45mm which is more than 35mm depicting left ventricular hypertrophy. The EKG also shows an R wave in lead aVL (23mm) which is more than 11mm. Thus, both conditions in Sokolow and Lyon criteria are fulfilled.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh2.jpg


Shown below is an EKG with an R wave in lead I (17mm) which is greater than 14mm. The S wave in lead V1 is 21 mm and R wave in lead V5 and/or V6 is around 24 mm. The sum is 45mm which is more than 35mm and thus left ventricular hypertrophy is present according to Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:LVH.png


Shown below is an EKG with an S wave in lead V1 (25mm) and an R wave in lead V6 (17mm). The sum is 42mm which is more than 35mm and therefore LVH is present according to Sokolow-Lyon criteria.

Copyleft image obtained courtesy of ECGpedia, http://en.ecgpedia.org/wiki/File:Extreme_lvh.jpg

For more EKG examples of left ventricular hypertrophy click here.


References

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