Left Ventricular Hypertrophy

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.

Select electrocardiographic criterial for Left ventricular hypertrophy.

Examples

Left Ventricular Hypertrophy

This ECG is a mimic of left ventricular hypertrophy and right atrial enlargement in a very young, thin individual. Just as increased soft-tissue impedance from adipose or edema can influence the surface ECG by dampening the conduction of electrical impulses, an especially slender body habitus can have the inverse effect. In this case, the various electrocardiographic abnormalities were simply amplifications of normal cardiac activity. One potentially helpful hint is the combination of LVH with RAD – the former when truly representative of ventricular hypertrophy being more commonly associated with leftward axis deviation.

Left Ventricular Hypertrophy

Classic findings of left ventricular hypertrophy including large amplitude QRS complexes and associated repolarization abnormalities (e.g., asymmetric T-wave inversion in V6).

Left Ventricular Hypertrophy

Classic findings of left ventricular hypertrophy including lateral (and inferior) downsloping ST-segment depressions and asymmetric T-wave inversions.

Hypertrophic Cardiomyopathy

This patient has known hypertrophic cardiomyopathy. Notice the large QRS complexes in V5 and V6 with associated repolarization abnormalities. There are also notched P waves in the inferior leads (i.e., P mitrale appearance) representing left atrial enlargement.

Left Ventricular Hypertrophy

Large QRS complexes, ST-segment depressions and asymmetric T wave inversions primarily in the lateral leads (I, aVL, V5, V6) are classic for left ventricular hypertrophy.

Left Ventricular Hypertrophy

A large QRS complex in aVL (greater than 11 mm) indicates left ventricular hypertrophy. The left axis deviation, slight intraventricular conduction delay, and absent R wave progression across the precordium are all likely explained by left ventricular hypertrophy. The large, downward deflected P wave in V1 and wide P wave in lead II (greater than 120 ms) indicates left atrial enlargement.

References

Wagner GS, Macfarlane P, Wellens H, et al. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram. Part V: Electrocardiogram Changes Associated With Cardiac Chamber Hypertrophy. Circulation. 2009;53(11):1003-1011.