Left Ventricular Hypertrophy

The left ventricle hypertrophies in response to pressure overload

This is usually secondary to conditions such as aortic stenosis and hypertension

This results in increased R wave amplitude in the left-sided ECG leads (I, aVL and V4-6) and increased S wave depth in the right-sided leads (III, aVR, V1-3)

The thickened LV wall leads to prolonged depolarisation (increased R wave peak time) and delayed repolarisation (ST and T-wave abnormalities) in the lateral leads.

Causes of LVH

- Hypertension (most common cause)
- Aortic stenosis
- Aortic regurgitation
- Mitral regurgitation
- Coarctation of the aorta
- Hypertrophic cardiomyopathy

ECG Changes

This results in increased R wave amplitude in the left-sided ECG leads (I, aVL and V4-6) and increased S wave depth in the right-sided leads (III, aVR, V1-3)

The thickened LV wall leads to prolonged depolarisation (increased R wave peak time) and delayed repolarisation (ST and T-wave abnormalities) in the lateral leads

The most commonly used are the Sokolov-Lyon criteria (S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm)

Voltage criteria must be accompanied by non-voltage criteria to be considered diagnostic of LVH.

Diagnostic Criteria

The most commonly used are the Sokolov-Lyon criteria (S wave depth in V1 + tallest R wave height in V5-V6 > 35 mm)

Voltage Criteria

Limb Leads

R wave in lead I + S wave in lead III > 25 mm

R wave in aVL > 11 mm

R wave in aVF > 20 mm

S wave in aVR > 14 mm

Precordial Leads

R wave in V4, V5 or V6  > 26 mm

R wave in V5 or V6 plus S wave in V1 > 35 mm

Largest R wave plus largest S wave in precordial leads > 45 mm

Non Voltage Criteria

Increased R wave peak time > 50 ms in leads V5 or V6

ST segment depression and T wave inversion in the left-sided leads: AKA the left ventricular ‘strain’ pattern

R wave peak time

Additional ECG changes seen in LVH

LVH Quiz

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