Left ventricular hypertrophy

1


Left ventricular hypertrophy Voltage criteria

• Voltage criteria (less accurate among patients less than age 40)
• Limb leads
1. R wave in lead 1 plus S wave in lead III >25 mm
2. R wave in lead aVL >11 mm
3. R wave in lead aVF >20 mm
4. S wave in lead aVR >14 mm
• Precordial leads
1. R wave in leads V4, V5, or V6 >26 mm
2. R wave in leads V5 or 6 plus S wave in lead V1 >35 mm
3. Largest R wave plus largest S wave in precordial leads >45 mm
• Non-voltage criteria
1. May be confused with ischemic changes [*]
2. Delayed ventricular activation time 0.05 s in leads V5 or V6 0.05 s
3. ST segment depression and T wave inversion in the left precordial leads [*]

Scoring system – LVH if points are 5 or more

• More specific, less sensitive [*]
• Amplitude (any of the following) 3 points
1. Largest R or S wave in limb leads 20 mm
2. S wave in leads V1 or V2 30 mm
3. R wave in leads V5 or V6 30 mm
• ST-T wave segment changes typical for LVH in the absence of digitalis 3 points
• Left atrial involvement 3 points
• Left axis deviation 2 points
• QRS duration of 0.09 s 1 point
• Delayed ventricular activation time in leads V5 and V6 of 0.05 s 1 point

BMJ 2002;324:1264-1267