Left ventricular hypertrophy electrocardiogram: Difference between revisions
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*Lead V<sub>6</sub>: R wave > 20 mm | *Lead V<sub>6</sub>: R wave > 20 mm | ||
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The EKG below shows 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 | The EKG below shows 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. | ||
[[Image:Left ventricular hypertrophy1.jpg|center|500px]] | [[Image:Left ventricular hypertrophy1.jpg|center|500px]] | ||
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The EKG below shows left ventricular hypertrophy according to the | The EKG below shows left ventricular hypertrophy according to the Sokolow-Lyon criteria. | ||
[[Image:LVH 2.jpg|center|500px]] | [[Image:LVH 2.jpg|center|500px]] | ||
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For more EKG examples of left ventricular hypertrophy click [[Left ventricular hypertrophy EKG examples|here]]. | For more EKG examples of left ventricular hypertrophy click [[Left ventricular hypertrophy EKG examples|here]]. | ||
==References== | ==References== | ||
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Revision as of 16:23, 17 October 2012
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Left ventricular hypertrophy Microchapters |
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Differentiating Left ventricular hypertrophy from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Left ventricular hypertrophy On the Web |
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American Roentgen Ray Society Images of Left ventricular hypertrophy |
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Directions to Hospitals Treating Left ventricular hypertrophy |
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Risk calculators and risk factors for Left ventricular hypertrophy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
The electrocardiogram (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.
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 ECG 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
The EKG below shows 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.
The EKG below shows left ventricular hypertrophy according to the Sokolow-Lyon criteria.
The EKG below shows extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis.
The EKG below shows features of left ventricular hypertrophy in the individual leads.
For more EKG examples of left ventricular hypertrophy click here.
References
- Sokolow Sokolow M, Lyon TP: The ventricular complex in left verntricular hypterfophy as obtained by unipolar precordial and limb leads. Am Heart J 37: 161, 1949
- Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men Circulation. 2001 May 15;103(19):2346-51. PMID 11352882
- Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB.Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994 Oct;90(4):1786-93.Related Articles, Links PMID 7923663
- Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P (1987). "Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings". Circulation. 75 (3): 565–72. PMID 2949887.
- Marriott, Henry J. L.; Wagner, Galen S. (2001). Marriott's practical electrocardiography. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0683307460.
- Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5