LVH criteria

Question 1

What is the most commonly used voltage criterion for diagnosing LVH?

Answer 1

Sokolow-Lyon criteria: S wave depth in V1 + tallest R wave height in V5 or V6 > 35 mm

This criterion requires a combination of both S wave depth and R wave height to be diagnostic.

Question 2

What must voltage criteria be accompanied by to be considered diagnostic of LVH?

Answer 2

Non-voltage criteria

Non-voltage criteria include specific ECG changes that must be present alongside voltage criteria.

Question 3

What is the limb lead voltage criterion for diagnosing LVH?

Answer 3

R wave in lead I + S wave in lead III > 25 mm

Other limb lead criteria include R wave in aVL > 11 mm, R wave in aVF > 20 mm, and S wave in aVR > 14 mm.

Question 4

List the precordial lead voltage criteria for diagnosing LVH.

Answer 4

R wave in V4, V5 or V6 > 26 mm
R wave in V5 or V6 plus S wave in V1 > 35 mm
Largest R wave plus largest S wave in precordial leads > 45 mm

Question 5

What is the non-voltage criterion related to R wave peak time in LVH?

Answer 5

1. Increased R wave peak time > 50 ms in leads V5 or V6
2. ST segment depression and T wave inversion in the left-sided leads: AKA the left ventricular ‘strain’ pattern

This criterion indicates prolonged depolarization associated with LVH.

Question 6

What are the ST segment and T wave changes indicative of in LVH?

Answer 6

ST segment depression and T wave inversion in the left-sided leads

This pattern is also known as the left ventricular ‘strain’ pattern.

Question 7

What causes the left ventricle to hypertrophy?

Answer 7

Pressure overload secondary to conditions such as aortic stenosis and hypertension

The hypertrophy results in increased R wave amplitude and increased S wave depth in the respective ECG leads.

Question 8

What additional ECG changes are seen in LVH?

Answer 8

• Left atrial enlargement
• Left axis deviation
• ST elevation in the right precordial leads V1-3
• Prominent U waves

These changes are associated with the structural and electrical adaptations of the heart in response to LVH.

Question 9

What is the voltage criterion for LVH using V2 and V5?

Answer 9

S wave in V2 + R wave in V5 > 35 mm

This specific measurement is part of the voltage criteria for diagnosing LVH.

Question 10

Fill in the blank: The most common cause of LVH is _______.

Answer 10

Hypertension

Other causes include aortic stenosis, aortic regurgitation, mitral regurgitation, coarctation of the aorta, and hypertrophic cardiomyopathy.

Question 11

True or False: LVH can result from aortic regurgitation.

Answer 11

True

Aortic regurgitation is one of the conditions that can lead to left ventricular hypertrophy.

Question 12

LVH ECG

Answer 12