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This document provides information on ECG changes that indicate left ventricular hypertrophy (LVH). It discusses various criteria for diagnosing LVH based on increased QRS voltages, ST segment and T wave changes, and the effect of bundle branch blocks. Specific criteria are given for diagnosing LVH in the presence of left or right bundle branch block. The document also includes example ECGs of patients with features indicating LVH.
Исходное описание:
A guide for health care professional to understand & interpret ECG changes in LVH.
This document provides information on ECG changes that indicate left ventricular hypertrophy (LVH). It discusses various criteria for diagnosing LVH based on increased QRS voltages, ST segment and T wave changes, and the effect of bundle branch blocks. Specific criteria are given for diagnosing LVH in the presence of left or right bundle branch block. The document also includes example ECGs of patients with features indicating LVH.
This document provides information on ECG changes that indicate left ventricular hypertrophy (LVH). It discusses various criteria for diagnosing LVH based on increased QRS voltages, ST segment and T wave changes, and the effect of bundle branch blocks. Specific criteria are given for diagnosing LVH in the presence of left or right bundle branch block. The document also includes example ECGs of patients with features indicating LVH.
If there is left ventricular hypertrophy then this will result in :
1 a tall R wave (greater than 25mm in V5 or V6), or R plus S greater than 35 mm (1) 2 a deep S in V1 or V2 3 if there is significant left ventricular strain then there are also inverted ! waves in V5 and V6 and possi"le S! depression # left a$is deviation ma% also "e present 5 &RS ma% "e slightl% prolonged 'otes( 1) a s%stematic review investigating the accurac% of )*+s in the diagnosis of ,V- has "een underta.en 2) /rom the stud% data in primar% care, a negative electrocardiogram result would reduce the t%pical pre0test pro"a"ilit% from 331 to 3112 3n secondar% care the t%pical pre0test pro"a"ilit% of 651 would "e reduced to 631 the authors concluded that electrocardiographic criteria should not "e used to rule out left ventricular h%pertroph% in patients with h%pertension Ventricular Hypertrophy LVH - ECG abnormalities that may be observed in patients with LVH 1 Increased QRS voltage (valid in patients >35 years of age). 2 Secondary changes of the ST segent and!or T "aves (Strain pattern ). 3 #eft a$is deviation (is a s%pportive finding& not diagnostic). ' (rolongation of the QT interval (is a s%pportive finding& not diagnostic). 5 (rolongation of the QT interval (is a s%pportive finding& not diagnostic). ) (rolongation of the QRS d%ration. Voltage criteria used to diagnose left ventricular hypertrophy Cornell voltage criteria 1 in men: R in aVL + S in C3 >2.8 mV >28mm in !tan"ar" cali#ration$. 2 %n &omen: R in aVL + S in C3 >2.' mV >2'mm in !tan"ar" cali#ration$. 3 (he relia#ility o) Cornell *olta+e criteria "ecrea!e! in the pre!ence o) le)t anterior )a!cicular #loc,. Soolow!Lyon criteria 1 S in V1 + R in C- or C.$ >3.-mV >3-mm in !tan"ar" cali#ration$. 2 R in aVL >1.1 mV >11mm in !tan"ar" cali#ration$. "dditional voltage criteria proposed for the diagnosis of left ventricular hypertrophy 1 R% + S%%% > 2- mm 2.- mV$ /u#ner0 1123$. 2 R% > 1- mm 1.- mV$ /u#ner0 1123$. 3 %n men0 S &a*e in C3 + R &a*e in aVL > 28mm 2.8mV$ Ca!ale0 118-$. 2 %n &omen0 S &a*e in C3 + R &a*e in aVL > 2'mm 2.'mV$ Ca!ale0 118-$. - R + S > 11mm 1.1 mV$ in any e3tremity lea" Romhilt0 11.8$. Secondary S# Segment and # wave changes in left ventricular hypertrophy 1 4epre!!ion o) the 5 point. 2 6p&ar"ly con*e30 "o&n !lopin+ S( !e+ment "epre!!ion. 3 7!ymmetric ( &a*e ne+ati*ity. $undle branch blocs and the diagnosis of LVH 1 %n the pre!ence o) ri+ht #un"le #ranch #loc, R888$0 the "ia+no!i! o) LVH #ecome! more "i))icult !ince the amplitu"e o) S &a*e in ri+ht precor"ial lea"! C10 C20 C3$ "ecrea!e!. 2 (he relia#ility o) Cornell *olta+e criteria "ecrea!e! in the pre!ence o) le)t anterior )a!cicular #loc,. "lthough not universally accepted% the following criteria are proposed for the diagnosis of LVH in the presence of left bundle branch bloc &L$$$' 1 Le)t atrial a#normality. 2 9RS &i"th > 1.' mili!econ"!. 3 (he !um o) the amplitu"e! o) S &a*e in C2 an" R &a*e in C. > 2-mm 2.-mV$. 2 (he amplitu"e o) S &a*e in C2 i! at lea!t 3' mm 3mV$. - (he amplitu"e o) S &a*e in C3 i! at lea!t 2- mm 2.-mV$. . S%% > R%%. Some of the criteria that are suggested for the diagnosis of LVH in the presence of right bundle branch bloc &($$$' are 1 (he amplitu"e o) S &a*e in C1 > 2mm '.2 mV$. 2 (he R &a*e amplitu"e in C- or C. > 1- mm 1.-mV$. 3 9RS a3i! i! le)t to the -3' "e+ree!. 2 R% > 11mm 1.1mV$. - Re+ar"in+ the amplitu"e! o) S &a*e in lea" %%% an" R &a*e in any precor"ial lea"0 the R:S amplitu"e > 3' mm 3 mV$ (eferences Circulation )**+%,,+-e).,!e)/,. Chest ,+0,1.+-,02!,00. "m Heart 3 ,+421,*4-.*)!.*/. 3 Electrocardiol ,+421,0-,.0!,/*. "m 3 Cardiol ,+4.1..-,*5!,*/. ECG ,. #he above ECG belongs to a patient with coarctation of the aorta and hypertension. #he terminal half of the 6 wave in C, is clearly negative and 6 wave in lead 77 is double peaed suggesting left atrial abnormality. #he left ventricular hypertrophy due to chronic arterial hypertension has resulted in high amplitude ( waves in lead C2 and deep S waves in lead C5 . #he S# segment depression and asymmetrical negative # waves in leads C. ve C/ denote to left ventricular strain pattern. ECG ). #he above ECG belongs to a male patient with systemic hypertension% left ventricular dilatation and hypertrophy. "ccording to the Soolow!Lyon voltage criteria% the sum of the amplitudes of the S wave in C, and ( wave in C. is 85.. mV &5. mm' and suggests LVH. 7n addition to the voltage criteria% there is also accompanying S# segment depression and asymmetrically negative # waves . #he rhythm is atrial fibrillation. ECG 5. #he above ECG belongs to a patient with systemic hypertension and coronary artery disease. #he ECG shows left ventricular hypertrophy and left atrial abnormality . ECG 2. #he ECG above belongs to a man with long!standing systemic arterial hypertension and a recently diagnosed adenoma in right adrenal gland. He needs 2 different medications to control his blood pressure. Still% no increased voltage is observed in the precordial leads. 9n the other hand% according to the Gubner e:tremity electrode voltage criteria% the sum of the amplitudes of ( wave in lead 7 and S wave in lead 777 is 8).. mV &). mm'% suggesting LVH in this patient. ECG .. #he ECG above belongs to a 2* years!old man with hypertension. "ccording to the Soolow!Lyon voltage criteria% the sum of the amplitudes of S wave in C, or C) and ( wave in C. or C/ is 85.. mV &5. mm' and suggests the presence of LVH. #his ECG does not show left ventricular strain pattern. ECG /. #he ECG above belongs to a patient with hypertension and echocardiographically confirmed LVH. His coronary arteries are normal. #he asymmetrical # wave negativity in the above ECG is not related to myocardial ischemia. ECG 0. #he ECG above shows right bundle branch bloc &($$$'. His echocardiogram showed septal LVH. 7n the ECG above% the criteria that suggest LVH are- amplitude of S wave in C, is 8 )mm &*.) mV'1 amplitude of ( wave in C. 8 ,.mm &,.. mV'. ECG 4. #he ECG above belongs to a patient with systemic arterial hypertension and mitral stenosis. His echocardiography showed diffuse LVH. Her ECG also suggests LVH. ECG +. #he ECG above belongs to a patient with hypertension and coronary artery disease. He had undergone coronary artery bypass graft surgery. ;espite ($$$ &right bundle branch bloc'% his ECG suggests LVH. His echocardiogram showed concentric &diffuse' LVH. ECG ,*. #he ECG above belongs to a hypertensive woman with normal coronary arteries and shows anterolateral # wave negativity and upsloping S# segment depression in leads V2 to V/ . ECG ,,. #he ECG above belongs to a ., years!old woman with hypertension and normal coronary arteries. "ccording to the Gubner e:tremity electrode voltage criteria% the sum of the amplitudes of ( wave in lead 7 and S wave in lead 777 is 8).. mV &). mm'% suggesting LVH in this patient. Echocardiogram confirmed LVH in this patient. ECG ,). #he ECG above belongs to a ./ years!old hypertensive man with normal coronary arteries. Less than , mm S# depression % negative # waves and < waves are seen. ECG ,5. #he ECG above belongs to a 2/ years!old hypertensive man who has echocardiographically confirmed left ventricular hypertrophy. 7t shows right bundle branch bloc and left anterior fascicular bloc. "ccording to Gubner criteria% there is also left ventricular hypertophy pattern. ECG ,2. #he ECG above belongs to a chronic hypertensive man with long!standing uncontrolled hypertension. His echocardiogram showed left ventricular septal hypertrophy. "ccording to Gubner criteria% the ( amplitude in 7 is 8 ,. mm &8,.. mV' and suggests the presence of left ventricular hypertrophy. ECG ,.. #he ECG above belongs to a 00 years!old woman who had never underwent diagnostic coronary angiography. #here are no signs of old myocardial infarction. Echocardiography shows left ventricular hypertrophy however the ECG does not give any clues to that. ($$$ impairs the ECG diagnosis of left ventricular hypertrophy. ECG ,/. #he ECG of a 2. years!old dilated cardiomyopathy patient with normal coronary arteries and prosthetic aortic and mitral valves. 7n addition to increased voltage the S# segment depression and asymmetrical # wave negativity in lateral leads show left ventricular strain &strain pattern'. #he rhythm is atrial fibrillation. ECG ,0. #he ECG above belongs to a woman with long!standing chronic systemic arterial hypertension. She had e:perienced syncope 2 days ago due to acute pulmonary embolism. #he ECG shows accelerated =unctional rhythm. Heart rate &ventricular rate' is about 45>minute. #here is also ectopic atrial tachycardia. #he atrial rate is about ,/.>minute. 6 waves are not related to the ?(S comple:es- complete "V bloc. #he increased voltage in this ECG suggests left ventricular hypertrophy. ECG ,4. #he ECG above belongs to a 2+ years!old diabetic man with long!standing &,0 years' hypertension. ECH9cardiography showed diffuse left ventricular hypertrophy. #his ECG is compatible with left ventricular hypertrophy according to both the Gubner and the Cornell voltage criteria. ECG ,+. #he ECG above belongs to a 2 years!old boy who had been operated for "trioVentricular Canal ;efect &"VC;>"VS;'. He had also undergone prosthetic mitral valve implantation. His ECH9cardiogram showed a dilated left ventricle. #his ECG shows right bundle branch in association with left ventricular hypertrophy. 6ediatric cardiologist ;r. @ahmut Godemir has donated this ECG to our website. ECG )*. #he ECG above belongs to an apparently healthy% 4 years!old lean boy. His ECH9cardiogram is normal- no left ventricular hypertrophy. #he ECG of a lean person with a low body mass inde: may show increased voltage as a normal variant. 6ediatric cardiologist ;r. @ahmut Godemir has donated the above ECG to our website. ECG ),. #he ECG above belongs to an apparently healthy% ,, years!old lean boy. His echocardiogram is normal. #he ECG of a lean person with low body mass inde: may show increased voltage as a normal variant. 6ediatric cardiologist ;r. @ahmut Godemir has donated the above ECG to our website.