Electrocardiographic findings in left ventricular hypertrophy

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Electrocardiographic findings in left ventricular hypertrophy Classification and external resources
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Criteria For Left Ventricular Hypertrophy (LVH)

Sokolow and Lyon Criteria

1. Add the depth of the S wave in V1 to the height of the R wave in lead V5 or V6 (whichever is taller) and if the sum is greater than 35 mm then LVH is present.
2. This criterion correlates well with the thickness of the LV walls and the diameter of the LV cavity as determined by ECHO.
3. Sensitivity 22% and specificity of 100%.^[1]

Effects of LAHB on Diagnosing Acute myocardial infarction and left ventricular hypertrophy

LAHB may be a cause of poor R wave progression across the precordium causing a pseudoinfarction pattern mimicking an anteroseptal infarction. It also makes the electrocardiographic diagnosis of LVH more complicated, because both may cause a large R wave in lead aVL. Therefore to call LVH on an EKG in the setting of an LAHB you should see the presence of a “strain” pattern when you are relying on limb lead criteria to diagnose LVH.^[2]

Cornell Voltage Criteria

1. Add the height of the R wave in lead aVL to the depth of the S wave in lead V3.
2. LVH if the sum is > 28mm in men or > 20 mm in women.
3. Sensitivity of 42% and specificity of 96%.^[3]

Roberts Criteria

1. Add the QRS voltage in all 12 leads and LVH is present if the voltage exceeds 175 to 225 mm.^[4]

Estes Criteria

1. R or S in limb lead: 20 mm or more
   • S in V1, V2, or V3: 25 mm or more 3 points
   • R in V4, V5, or V6: 25 mm or more
2. Any ST shift (without digitalis): 3 points
   • Typical "strain" ST T (with digitalis): 1 points
3. LAD: 15 degrees or more: 2 points
4. QRS interval: 0.09 seconds or more: 1 point
5. Intrinsicoid deflection in V5 or V6 of 0.04 seconds or more: 1 point
6. P terminal force in V1 more than 0.04 sec: 1 point

Total possible: 13 points

Total of 5 points = LVH, 4 points = probable LVH^[5]

References

Additional resources

• ECGpedia: Course for interpretation of ECG
• The whole ECG - A basic ECG primer
• 12-lead ECG library
• Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG
• ECG information from Children's Hospital Heart Center, Seattle
• ECG Challenge from the ACC D2B Initiative
• National Heart, Lung, and Blood Institute, Diseases and Conditions Index
• A history of electrocardiography
• EKG Interpretations in infants and children

Diagrams and EKG Findings

v • d • e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

v • d • e WikiDoc Research Resources for Electrocardiographic findings in left ventricular hypertrophy
Articles on Electrocardiographic findings in left ventricular hypertrophy	Most recent articles on Electrocardiographic findings in left ventricular hypertrophy • Most cited articles on Electrocardiographic findings in left ventricular hypertrophy • Review articles on Electrocardiographic findings in left ventricular hypertrophy • Articles on Electrocardiographic findings in left ventricular hypertrophy in N Eng J Med, Lancet, BMJ
Media (Slides, Video, Images, MP3) on Electrocardiographic findings in left ventricular hypertrophy	Powerpoint slides on Electrocardiographic findings in left ventricular hypertrophy • Images of Electrocardiographic findings in left ventricular hypertrophy • Photos of Electrocardiographic findings in left ventricular hypertrophy • Podcasts & MP3s on Electrocardiographic findings in left ventricular hypertrophy • Videos on Electrocardiographic findings in left ventricular hypertrophy
Evidence Based Medicine Regarding Electrocardiographic findings in left ventricular hypertrophy	Cochrane Collaboration on Electrocardiographic findings in left ventricular hypertrophy • Bandolier on Electrocardiographic findings in left ventricular hypertrophy • TRIP on Electrocardiographic findings in left ventricular hypertrophy
Cost Effectiveness of Electrocardiographic findings in left ventricular hypertrophy	Cost Effectiveness of Electrocardiographic findings in left ventricular hypertrophy
Clinical Trials Involving Electrocardiographic findings in left ventricular hypertrophy	Ongoing Trials on Electrocardiographic findings in left ventricular hypertrophy at Clinical Trials.gov • Trial results on Electrocardiographic findings in left ventricular hypertrophy • Clinical Trials on Electrocardiographic findings in left ventricular hypertrophy at Google
Guidelines / Policies / Government Resources (FDA/CDC) Regarding Electrocardiographic findings in left ventricular hypertrophy	US National Guidelines Clearinghouse on Electrocardiographic findings in left ventricular hypertrophy • NICE Guidance on Electrocardiographic findings in left ventricular hypertrophy • NHS PRODIGY Guidance • FDA on Electrocardiographic findings in left ventricular hypertrophy • CDC on Electrocardiographic findings in left ventricular hypertrophy
Textbook Information on Electrocardiographic findings in left ventricular hypertrophy	Books and Textbook Information on Electrocardiographic findings in left ventricular hypertrophy
Pharmacology Resources on Electrocardiographic findings in left ventricular hypertrophy	Dosing of Electrocardiographic findings in left ventricular hypertrophy • Drug interactions with Electrocardiographic findings in left ventricular hypertrophy • Side effects of Electrocardiographic findings in left ventricular hypertrophy • Allergic reactions to Electrocardiographic findings in left ventricular hypertrophy • Overdose information on Electrocardiographic findings in left ventricular hypertrophy • Carcinogenicity information on Electrocardiographic findings in left ventricular hypertrophy • Electrocardiographic findings in left ventricular hypertrophy in pregnancy • Pharmacokinetics of Electrocardiographic findings in left ventricular hypertrophy •
Genetics, Pharmacogenomics, and Proteinomics of Electrocardiographic findings in left ventricular hypertrophy	Genetics of Electrocardiographic findings in left ventricular hypertrophy • Pharmacogenomics of Electrocardiographic findings in left ventricular hypertrophy • Proteomics of Electrocardiographic findings in left ventricular hypertrophy
Newstories on Electrocardiographic findings in left ventricular hypertrophy	Electrocardiographic findings in left ventricular hypertrophy in the news • Be alerted to news on Electrocardiographic findings in left ventricular hypertrophy • News trends on Electrocardiographic findings in left ventricular hypertrophy
Commentary on Electrocardiographic findings in left ventricular hypertrophy	Blogs on Electrocardiographic findings in left ventricular hypertrophy
Patient Resources on Electrocardiographic findings in left ventricular hypertrophy	Patient resources on Electrocardiographic findings in left ventricular hypertrophy • Discussion groups on Electrocardiographic findings in left ventricular hypertrophy • Patient Handouts on Electrocardiographic findings in left ventricular hypertrophy • Directions to Hospitals Treating Electrocardiographic findings in left ventricular hypertrophy • Risk calculators and risk factors for Electrocardiographic findings in left ventricular hypertrophy
Healthcare Provider Resources on Electrocardiographic findings in left ventricular hypertrophy	Symptoms of Electrocardiographic findings in left ventricular hypertrophy • Causes & Risk Factors for Electrocardiographic findings in left ventricular hypertrophy • Diagnostic studies for Electrocardiographic findings in left ventricular hypertrophy • Treatment of Electrocardiographic findings in left ventricular hypertrophy
Continuing Medical Education (CME) Programs on Electrocardiographic findings in left ventricular hypertrophy	CME Programs on Electrocardiographic findings in left ventricular hypertrophy
International Resources on Electrocardiographic findings in left ventricular hypertrophy	Electrocardiographic findings in left ventricular hypertrophy en Espanol • Electrocardiographic findings in left ventricular hypertrophy en Francais
Business Resources on Electrocardiographic findings in left ventricular hypertrophy	Electrocardiographic findings in left ventricular hypertrophy in the Marketplace • Patents on Electrocardiographic findings in left ventricular hypertrophy
Informatics Resources on Electrocardiographic findings in left ventricular hypertrophy	List of terms related to Electrocardiographic findings in left ventricular hypertrophy