There are several criteria out there for left ventricular hypertrophy, and none of them are particularly sensitive. They’re all less than 50% sensitive, but they’re usually quite specific – 85 to 90%. The most cited criteria are the Sokolow-Lyon and the Cornell criteria, which consider voltage amplitude. There are also ST/T wave changes associated with LVH that may increase the specificity when seen. Namely, lateral ST depressions and asymmetric T wave inversions.
Left ventricular hypertrophy is one of the most common reasons for false activations of the catheterization lab. It often causes discordant ST-elevation in the anterior precordial leads. Armstrong, et al., proposed an algorithm for interpreting acute myocardial infarction in the setting of hypertrophy. Specifically in leads V1 through V3, ST-elevation greater than 25% of the R-S amplitude is likely to be an acute myocardial infarction.