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Left Ventricular Hypertrophy Related EKG Changes

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Left Ventricular Hypertrophy Related EKG Changes, Estes Criteria, LVH with Repolarization Abnormality, Left Ventricular Hypertrophy with Repolarization Abnormality, LVH with Strain Pattern, Left Ventricular Hypertrophy with Strain Pattern

  • See Also
  1. Left Ventricular Hypertrophy
  • Differential Diagnosis
  1. High Left Ventricular Voltage (HLVV)
    1. Large amplitude QRS Complexes are a normal variant in young, healthy athletes (not LVH)
    2. Avoid using QRS amplitude alone to diagnose LVH in age <40-45 years old
  • Criteria
  • Quick Measures consistent with LVH
  1. (S in V1 or V2) + (R in V5 or V6) >35 mm (over age 35)
  2. R in AVL > 12 mm
  • Criteria
  • Scott
  1. Limb Leads
    1. R in I added to S in III exceed 25 mm
    2. R in aVL exceeds 7.5 mm
    3. R in aVF exceeds 20 mm
    4. S in aVR exceeds 14 mm
  2. Chest Leads
    1. S in V1 (or V2) Added to R in V5 (or V6) exceed 35 mm
    2. R in V5 or V6 exceeds 26 mm
    3. R + S in any precordial lead exceeds 45 mm
  • Criteria
  • Estes
  1. Major criteria: 3 points if all present
    1. R or S in limb lead exceeds 19 mm
    2. S in V1 or V2 exceeds 29 mm
    3. R in V5 or V6 exceeds 30 mm
  2. Other Criteria
    1. Any ST shift without Digoxin: 3 points
    2. ST Strain pattern without Digoxin: 1 point
    3. Left Axis Deviation beyond -30 degrees: 2 points
    4. QRS wider than 0.09 seconds: 1 point
    5. Intrinsicoid deflection in V5-6 over 0.05: 1 point
    6. P-terminal force in V1 exceeds 0.04: 3 points
  3. Interpretation
    1. Left Ventricular Hypertrophy: 5 points
    2. Probable Left Ventricular Hypertrophy: 4 points
  • Findings
  • LVH with Repolarization Abnormality (or Strain Pattern)
  1. Precautions
    1. LVH with Repolarization Abnormality may be confused with acute Myocardial Infarction
    2. Always exclude Acute Coronary Syndrome
    3. Compare old Electrocardiograms
  2. Asymmetric T Wave Inversion
    1. Leads I, aVL, V4, V5, V6
  3. ST segment Depression (mild)
    1. Leads I, aVL, V4, V5, V6
  • References
  1. Mattu (2019) Crit Dec Emerg Med 33(12): 15