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
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Related Studies
| Definition (NCI_CDISC) | An electrocardiographic finding suggestive of a hypertrophied left ventricle, characterized by large QRS amplitudes and secondary findings of left atrial enlargement, left axis deviation, or typical pattern of ST depression and T wave inversion. |
| Definition (NCI) | An electrocardiographic finding suggestive of a hypertrophied left ventricle, characterized by large QRS amplitudes and secondary findings of left atrial enlargement, left axis deviation, or typical pattern of ST depression and T wave inversion. (CDISC) |
| Concepts | Laboratory or Test Result (T034) |
| SnomedCT | 164876009, 164873001, 142036005, 142033002, 25488008 |
| English | ECG: LVH NOS, Ekg Left Ventricular Hypertrophy, Electrocardiogram: left ventricle hypertrophy, LVH (left ventricular hypertrophy) on ECG, ECG left ventricular hypertrophy, left ventricular hypertrophy, Electrocardiogram: left ventricle hypertrophy (finding), electrocardiogram left ventricular hypertrophy (procedure), electrocardiogram left ventricular hypertrophy, ecg lvh, ekg lvh, Left Ventricular Hypertrophy by ECG Finding, Electrocardiogram: left ventricle hypertrophy NOS, Electrocardiogram: left ventricle hypertrophy NOS (finding), ECG:left ventricle hypertrophy (finding), ECG: LVH NOS (finding), Left ventricular hypertrophy by EKG, Left ventricular hypertrophy by electrocardiogram (finding), Left ventricular hypertrophy by EKG (finding), Left ventricular hypertrophy by electrocardiogram, LVH by EKG, Left Ventricular Hypertrophy by EKG Finding, Left Ventricular Hypertrophy, LEFT VENTRICULAR HYPERTROPHY, ECG:left ventricle hypertrophy, ECG: LVH |
| Spanish | ECG: HVI, electrocardiograma: hipertrofia ventricular izquierda, SAI (hallazgo), electrocardiograma: hipertrofia ventricular izquierda, SAI, ECG: LVH NOS, ECG: HVI, SAI, ECG: hipertrofia ventricular izquierda, SAI, signos electrocardiográficos de hipertrofia ventricular izquierda, signos electrocardiográficos de hipertrofia de ventrículo izquierdo, signos electrocardiográficos de hipertrofia de ventrículo izquierdo (hallazgo), signos electrocardiográficos de hipertrofia ventricular izquierda (hallazgo), ECG con signos de HVI, ECG: hipertrofia de ventrículo izquierdo, electrocardiograma: hipertrofia de ventrículo izquierdo (hallazgo), electrocardiograma: hipertrofia de ventrículo izquierdo, signos electrocardiográficos de hipertrofia del ventrículo izquierdo |
Ontology: Left Ventricular Hypertrophy with Strain by ECG Finding (C3640865)
| Definition (NCI_CDISC) | An electrocardiographic finding suggestive of a hypertrophied left ventricle, characterized by large QRS amplitudes, ST depression and T wave inversion. |
| Definition (NCI) | An electrocardiographic finding suggestive of a hypertrophied left ventricle, characterized by large QRS amplitudes, ST depression and T wave inversion. (CDISC) |
| Concepts | Finding (T033) |
| English | Left Ventricular Hypertrophy with Strain by ECG Finding, Left Ventricular Hypertrophy with Strain by EKG Finding, LEFT VENTRICULAR HYPERTROPHY WITH STRAIN, Left Ventricular Hypertrophy With Strain |
Ontology: Repolarization Abnormality Secondary To Ventricular Hypertrophy (C3640898)
| Definition (NCI) | An electrocardiographic finding of ST depression and T wave inversion in the presence of increased QRS amplitude which are thought to be due to left ventricular hypertrophy. |
| Definition (NCI_CDISC) | An electrocardiographic finding of ST depression and T wave inversion in the presence of increased QRS amplitude which are thought to be due to left ventricular hypertrophy. |
| Concepts | Finding (T033) |
| English | Repolarization Abnormality Secondary To Ventricular Hypertrophy, ST-T change due to ventricular hypertrophy, REPOLARIZATION ABNORMALITY SECONDARY TO VENTRICULAR HYPERTROPHY |
