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Left Ventricular Hypertrophy

Tue, 05/26/2015 - 14:36 -- Dawn

This ECG shows voltage criteria for LVH (deep S waves V1-V3 and tall R waves V4 - V6). There are many criteria in use for determining LVH, but probably the most commonly used is the Sokolow-Lyon criteria.  This criteria says that if the voltage of the S wave in V1 PLUS the tallest R wave of V4, V5, and V6 equals 35 mm or more, the criteria are sufficient for LVH.

In order to diagnose LVH from the ECG, we must also show repolarization abnormalities, called the "strain pattern".  This is seen in sloping ST depressions in all leads with upright QRS complexes.  There will also be slight ST elevations (reciprocal to the depressions) in leads with negative QRSs.  Chest xray and echocardiogram are important in confirming the extent of the left ventricular enlargement. 

The axis of this ECG is not typical of LVH, as it is normal.  LVH usually has a left axis deviation.   In this ECG, Lead aVL appears to have a pathological Q wave.  Possible high lateral damage in the past has skewed the axis downward. The wide p waves in Lead II and the biphasic p waves in V1 may also indicate left atrial strain, a common finding with LVH, called "P mitrale".

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