left ventricular hypertrophy (LVH)


  • LVH results from chronic left-sided pressure or volume overload


ECG findings of LVH

  • exclude Left Bundle Branch Block (LBBB) - if present, cannot make ECG Dx of LVH
  • the most characteristic ECG finding of LVH is an increase in amplitude of the QRS resulting in tall R waves (and sometimes either tall T waves as well or ST depression with asymmetric T inversion and J point depression - “LVH with strain” pattern) in I, aVL, V5 and V6, with deeper S waves in V1-2.
  • there is often poor R wave progression in right and mid precordial leads, and indeed potentially an absent R wave in V1-2 creating a QS pattern in these leads.
  • LAH is an early ECG sign
  • most ECG scoring systems for LVH are not sufficiently sensitive (< 42%)

ECG diagnostic criteria for LVH

Sokolov-Lyon index

  • add voltages of S in V1 + R in V5 or V6 > 35mm
    • sens. 22%, spec. 100%

Cornell voltage criteria

  • add voltages of S in V3 + R in aVL > 28mm in men or > 20mm in women
    • sens. 42%, spec. 96%

Romhilt and Estes Point Score System

  • LVH is present if scores 5 or more, and is likely if scores 4
  • Score 3 if any of the following amplitude criteria are present:
    • any limb lead R wave or S wave 20mm or more
    • S wave in V1 or V2 30mm or more
    • R wave in V5 or V6 30mm or more
  • Score 3 if LVH ST/T changes and patient not on digoxin (score 1 if these are present and patient is on digoxin)
  • Score 3 if left atrial abnormality:
    • terminal negativity of P wave in lead V1 is at least 1mm with a duration of at least 0.04sec
  • Score 1 if QRS complex duration is 0.09 sec or more
  • Score 1 if intrinsicoid deflection in V5 or v6 of 0.05sec or more

RI, SIII rule

  • R in I + S in III > 25mm
    • sens. 11% but spec. 100%

R in aVL rule

  • R in aVL > 11mm
    • sens. 11% but spec. 100%
ecg_lvh.txt · Last modified: 2019/03/16 08:49 by wh