Left Ventricular Hypertrophy (LVH) - ECG Study

ECG criteria of LVH (voltage criteria):
• S wave in V1 + R wave  in V6 or V5 is > 35 mm (S V1 + R V6 > 35 mm).
(This criteria is applicable only above 25 years of age).

Other criteria of LVH:
• R in V5 (or V6) > 26 mm.
• R in aVL > 11 mm (or 13 mm).
• R in aVF > 20 mm (also in LII and LIII).
• R in LI + S in LIII > 25 mm.
• R in LI > 15 mm.
• R in V6 is equal to or greater than R in V5 (normally R in V5 is taller than R in V6).
• S in V1 or V2 > 25 mm.
• Sum of all QRS in all 12 leads > 175 mm.
• Left axis deviation (QRS between –30° and –90°).

                                         Left ventricular hypertrophy with strain

It is important to note that: In young and thin person, this voltage criteria is not diagnostic (in younger person, S in V1 + R in V5 or V6 should be greater than 40 mm).

Q. How to confirm the diagnosis of LVH?
Ans. By echocardiography (M-mode).

Q. What are the causes of LVH?
Ans. As follows:

• Systemic hypertension.
• Aortic stenosis.
• Coarctation of aorta.
• Hypertrophic cardiomyopathy.
• VSD.
• Mitral regurgitation.
• Aortic regurgitation.
• Patent ductus arteriosus.
• Coronary artery disease (long standing).

Q. How to diagnose LVH clinically?
Ans. Apex beat is heaving in nature.
Note: Apex beat is not shifted, as the hypertrophy is concentric type—at the expense of the cavity.

ECG Criteria of LVH with Strain
• Findings of LVH.
• ST depression and T inversion (in L1, aVL, V4 to V6).

Q. What are the differential diagnosis of LVH with strain?
Ans. As follows:
• Hypertrophic cardiomyopathy.
• Subendocardial myocardial infarction (T inversion is the cause of this confusion. However, in this case, T inversion is usually symmetrical, but no signs of LVH).

Q. How to confirm the diagnosis?
Ans. By echocardiography (2D or M mode).