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.