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

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.

• 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

Diagnostic ≥ 5 points and probable ≥ 4 points)

ECG Criteria	Points
Voltage Criteria (any of): R or S in limb leads ≥20 mm S in V1 or V2 ≥30 mm 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

• Hypertension (Main)
• Aortic Stenosis
• Aortic Regurgitation
• Coarctation of the Aorta
• Hypertrophic Cardiomyopathy
• Mitral Regurgitation

Differential Diagnosis

Cardiac Hypertrophy and Enlargement

• Right atrial enlargement
• Left atrial enlargement
• Left ventricular hypertrophy
• Right ventricular hypertrophy

See Also

• ECG (Main)

References

Authors

Ross Donaldson