Left Ventricular Hypertrophy

Background

  • The free wall typically grows the most, which directs more forces backwards, upwards, and left.  (Leftward Axis)

Causes

  • Acquired (Aortic Valve Disease, Hypertension)
  • Cardiomyopathies (Ischemic CMP, Genetic CMP)
  • Congenital Heart Disease (AS, Coarctation, fibroelastosis)

Criteria

Cornell Criteria:

  • R in aVL + S in V3 > 24mm in men, > 20mm in women
  • (Sensitivity: 22%, Specificity: 100%)

Sokolow-Lyon Criteria:

  • S in V1 + R in V5-6 ≥ 35mm
  • (Sensitivity: 42% Specificity: 96%)

Sokolow Index (aka “aVL Criteria”)

  • aVL ≥ 11mm
  • (Sensitivity: 9-13%, Specificity 99%)

Diagnosing Scoring Systems: (rarely used in practice)

  • i.e. Estes Score (scores ST changes, voltage criteria, and negative P-waves) and calculates probability of LVH

Associated Findings

  • Repolarization changes (ST depression, TWI) (i.e. strain pattern)
  • Atrial Fibrillation
  • Left Atrial Enlargement

Examples

LVH with repolarization abnormalities

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Further Reading

  • Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part V: electrocardiogram changes associated with cardiac chamber hypertrophy. Journal of the American College of Cardiology. 2009; 53(11):992-1002. 
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