Left Ventricular Hypertrophy
Let’s talk about left ventricular hypertrophy (LVH).
LVH is an abnormal increase in left ventricular mass in response to chronic pressure overload most commonly due to aortic valve disease, hypertensive heart disease, hypertrophic cardiomyopathy, and others.
There are several electrocardiographic criteria for diagnosis of LVH:
✅ Cornell criteria: R in aVL + S in V3: >28 mm in males and >20 mm in females.
✅ Sokolow-Lyon criteria: S in V1 or V2 + R in V5 or V6 >35 mm.
✅ Peguero-Lo Presti criteria: Deepest S wave in any lead + S in V4 ≥28 mm in males and ≥23 mm in females.
Others criteria suggestive of LVH include:
✅ R >12 mm in aVL.
✅ S in V1 or V2 >30 mm.
✅ R in V5 >26 mm and V6 >20 mm.
✅ R in aVR ≥15 mm.
✅ R in aVF ≥21 mm.
NOTE:
✅ Echo is more accurate than EKG for chamber hypertrophy/enlargement.
✅ Younger adults very often manifest increased QRS amplitude without left ventricular hypertrophy.
✅ The sensitivity of the voltage criteria can be decreased by obesity, pericardial effusion, COPD, pneumothorax and many others.
Graphic explanation
A good EKG with LVH (confirmed by echo)
Basic anatomical illustration of LVH.
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