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