Left ventricular hypertrophy: Difference between revisions

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__NOTOC__
{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name          = Left ventricular hypertrophy |
   Name          = Left ventricular hypertrophy |
  ICD10          = {{ICD10|I|51|7|i|30}} |
  ICD9          = {{ICD9|429.3}} |
  ICDO          = |
   Image          = Left VH gross.jpg|
   Image          = Left VH gross.jpg|
   Caption        = Left ventricular hpertrophy. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
   Caption        = Left ventricular hpertrophy. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
  OMIM          = |
  MedlinePlus    = |
  eMedicineSubj  = |
  eMedicineTopic = |
  DiseasesDB    = 7659 |
}}
}}
{{SI}}
'''For patient information, click [[Left ventricular hypertrophy (patient information)|here]]'''
{{WikiDoc Cardiology Network Infobox}}
{{LVH}}
{{CMG}}
{{CMG}} '''Associate Editor-In-Chief:''' {{CZ}}
__NOTOC__
'''Associate Editor-In-Chief:''' {{CZ}}
 
 


'''Left ventricular hypertrophy''' ('''LVH''') is the thickening of the [[myocardium]] (muscle) of the [[left ventricle]] of the [[heart]]. While [[ventricular hypertrophy]] can occur naturally as a reaction to [[aerobic exercise]] and strength training, it is most frequently referred to as a pathological reaction to [[cardiovascular disease]].
{{SK}} LVH.


While LVH itself is not a disease, it is usually a marker for disease involving the heart.  Disease processes that can cause LVH include any disease that increases the [[afterload]] that the heart has to contract against, and some primary diseases of the muscle of the heart.
==[[Left ventricular hypertrophy overview|Overview]]==
 
==[[Left_ventricular_hypertrophy historical perspective|Historical Perspective]]==
Causes of increased afterload that can cause LVH include [[aortic stenosis]], [[aortic insufficiency]], and [[hypertension]].  Primary disease of the muscle of the heart that cause LVH are known as [[hypertrophic cardiomyopathy|hypertrophic cardiomyopathies]].
==[[Left_ventricular_hypertrophy classification|Classification]]==
 
==[[Left_ventricular_hypertrophy pathophysiology|Pathophysiology]]==
== Complete Differential Diagnosis of Causes of Left Ventricular Hypertrophy==
==[[Left_ventricular_hypertrophy causes|Causes]]==
* [[Acromegaly]]
==[[Left_ventricular_hypertrophy differential diagnosis|Differentiating Left ventricular hypertrophy from other Diseases]]==
* [[Alcoholic cardiomyopathy]]
==[[Left_ventricular_hypertrophy epidemiology and demographics|Epidemiology and Demographics]]==
* [[Aortic coarctation]]
==[[Left_ventricular_hypertrophy risk factors|Risk Factors]]==
* [[Aortic regurgitation]]
==[[Left_ventricular_hypertrophy screening|Screening]]==
* [[Aortic stenosis]]
==[[Left_ventricular_hypertrophy_natural_history,_complications_and_prognosis|Natural History, Complications and Prognosis]]==
* [[Chronic Renal Failure]]
* [[Familial dilated and hypertrophic cardiomyopathy]]
* [[Hypertrophic cardiomyopathy]] ([[HCM]])
* [[Idiopathic dilated cardiomyopathy]]
* [[Mitral regurgitation]]
* [[Patent Ductus Arteriosus]]
* [[Restrictive cardiomyopathy]]
* [[Thalassemia]]


==Diagnosis==
==Diagnosis==
The principal method to diagnose LVH is [[echocardiography]], during which the thickness of the muscle of the heart can be measured.  The [[electrocardiogram]] (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram.
[[Left_ventricular_hypertrophy history and symptoms|History and Symptoms]] | [[Left_ventricular_hypertrophy physical examination|Physical Examination]] | [[Left_ventricular_hypertrophy laboratory findings|Laboratory Findings]] | [[Left_ventricular_hypertrophy electrocardiogram|Electrocardiogram]] | [[Left ventricular hypertrophy EKG examples|EKG Examples]] | [[Left_ventricular_hypertrophy chest x ray|Chest X Ray]] | [[Left_ventricular_hypertrophy CT|CT]] | [[Left_ventricular_hypertrophy MRI|MRI]] | [[Left_ventricular_hypertrophy echocardiography|Echocardiography]] | [[Left_ventricular_hypertrophy other imaging findings|Other Imaging Findings]] | [[Left_ventricular_hypertrophy other diagnostic studies|Other Diagnostic Studies]]


===Chest x-ray===
==Treatment==
[[Left_ventricular_hypertrophy medical therapy|Medical Therapy]] | [[Left_ventricular_hypertrophy surgery|Surgery]] | [[Left_ventricular_hypertrophy primary prevention|Primary Prevention]] | [[Left_ventricular_hypertrophy secondary prevention|Secondary Prevention]] | [[Left_ventricular_hypertrophy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Left_ventricular_hypertrophy future or investigational therapies|Future or Investigational Therapies]]


[http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
==Case Studies==
[[Left_ventricular_hypertrophy case study one|Case #1]]


<gallery>
==Related Chapters==
Image:Chest x ray LVH.jpg|Chest X-ray: Left Ventricular Hypertrophy in a patient with aortic valve stenosis
</gallery>
 
===Echocardiography===
 
Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as visualized on echocardiography correlates with its actual mass.  Normal thickness of the left ventricular myocardium is from 0.6 to 1.1 cm (as measured at the very end of [[diastole]]. If the myocardium is more than 1.1 cm thick, the diagnosis of LVH can be made.
 
===ECG criteria for LVH===
 
There are multiple criteria used to diagnose LVH via electrocardiography. None of them are perfect. However, by using multiple different criteria the [[sensitivity (tests)|sensitivity]] and [[Specificity (tests) | specificity]] are increased.
 
The Sokolow and Lyon criteria
*S in V1 + R in V5 or V6 (whichever is larger) =/> 35 mm
*R in aVL =/> 11 mm
 
The Cornell criteria<sup>1</sup> for the ECG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead V<sub>3</sub>.  The Cornell criteria for LVH are:
*S in V<sub>3</sub> + R in aVL > 28 mm (men)
*S in V<sub>3</sub> + R in aVL > 20 mm (women)
 
Other voltage-based criteria for LVH include:
 
*Lead I: R wave > 14 mm
*Lead aVR: S wave > 15 mm
*Lead aVL: R wave > 12 mm
*Lead aVF: R wave > 21 mm
 
*Lead V<sub>5</sub>: R wave > 26 mm
*Lead V<sub>6</sub>: R wave > 20 mm
 
 
<gallery>
Image:E_lvh.jpg|LVH: R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.
Image:LVH.jpg|ECG of patient with left ventricular hypertrophy according to the Sokolow-Lyon criteria
Image:Extreme_lvh2.jpg|Another example of extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis
</gallery>
 
 
<gallery>
Image:extreme_lvh.jpg|ECG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing
Image:LVH.png
</gallery>
 
==See also==
* [[Cardiomegaly]]
* [[Cardiomegaly]]
* [[Ventricular hypertrophy]]
* [[Ventricular hypertrophy]]
* [[Primary hyperparathyroidism]]
* [[Primary hyperparathyroidism]]
==References==
{{refbegin|2}}
#Sokolow Sokolow M, Lyon TP: ''The ventricular complex in left verntricular hypterfophy as obtained by unipolar precordial and limb leads.'' Am Heart J 37: 161, 1949
#Sundström J, Lind L, Arnlöv J, Zethelius B, Andrén B, Lithell HO. Echocardiographic and electrocardiographic diagnoses of left ventricular hypertrophy predict mortality independently of each other in a population of elderly men Circulation. 2001 May 15;103(19):2346-51. PMID 11352882
#Levy D, Salomon M, D'Agostino RB, Belanger AJ, Kannel WB.Prognostic implications of baseline electrocardiographic features and their serial changes in subjects with left ventricular hypertrophy. Circulation. 1994 Oct;90(4):1786-93.Related Articles, Links PMID 7923663
#{{cite journal |author=Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P |title=Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings |journal=Circulation |volume=75 |issue=3 |pages=565-72 |year=1987 |pmid=2949887 |doi=}}
#{{cite book |author=Marriott, Henry J. L.; Wagner, Galen S. |title=Marriott's practical electrocardiography |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2001 |pages= |isbn=0683307460 |oclc= |doi=}}
#Hammill S. C. Electrocardiographic diagnoses: Criteria and definitions of abnormalities, Chapter 18, MAYO Clinic, Concise Textbook of Cardiology, 3rd edition, 2007 ISBN 0-8493-9057-5
{{refend}}
==Additional resources==
* [http://en.ecgpedia.org ECGpedia: Course for interpretation of ECG]
* [http://www.anaesthetist.com/icu/organs/heart/ecg/ The whole ECG - A basic ECG primer]
* [http://www.ecglibrary.com 12-lead ECG library]
* [http://www.ecgsim.org Simulation tool to demonstrate and study the relation between the electric activity of the heart and the ECG]
* [http://heartcenter.seattlechildrens.org/what_to_expect/electrocardiogram.asp ECG information from Children's Hospital Heart Center, Seattle]
* [http://www.regionalpci-stemi.org/id10.html ECG Challenge from the ACC D2B Initiative]
* [http://0-www.nhlbi.nih.gov.innopac.up.ac.za:80/health/dci/Diseases/ekg/ekg_what.html National Heart, Lung, and Blood Institute, Diseases and Conditions Index]
* [http://www.ecglibrary.com/ecghist.html A history of electrocardiography]
* [http://www.health.gov.mt/impaedcard/issue/issue1/ipc00103.htm EKG Interpretations in infants and children]


{{Circulatory system pathology}}
{{Circulatory system pathology}}
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[[Category:Electrophysiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]


[[es:Hipertrofia ventricular izquierda]]
[[es:Hipertrofia ventricular izquierda]]

Latest revision as of 18:53, 9 January 2013

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Overview

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Causes

Differentiating Left ventricular hypertrophy from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | EKG Examples | Chest X Ray | CT | MRI | Echocardiography | Other Imaging Findings | Other Diagnostic Studies

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