Left ventricular hypertrophy (LVH) causes a tall QRS. There are various criteria for LVH. Diagnosis requires voltage and non-voltage criteria to be met.
- Limb leads
- R wave in lead I + S wave in lead III > 25 mm
- R wave in aVL > 11 mm
- R wave in aVF > 20 mm
- S wave in aVR > 14 mm
- Precordial Leads
- 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
- Increased R wave peak time > 50 ms in leads V5 or V6
- Left ventricular ‘strain’ pattern: ST segment depression and T wave inversion in the left-sided leads
These signs are not sensitive: LVH can be present but the ECG may still be relatively normal. There may also be signs of left atrial enlargement, left axis deviation and prominent U waves. LVH can be caused by hypertension, aortic stenosis or regurgitation, mitral regurgitation, coarctation of the aorta or hypertrophic cardiomyopathy.
- Hampton, J and Hampton, J (2019) - The ECG Made Easy, 9th edn, Elsevier
- Rowlands, A and Sargent, A (2019) - The ECG Workbook, 4th edn, M&K Publishing
- Thaler, MS (2018) - The Only EKG Book You'll Ever Need, 9th edn, Lippincott Williams and Wilkins
- Grauer, K (2014) - A 1st Book on ECGs - 2014, KG/EKG Press
- Grauer, K (2014) - ECG 2014 Pocket Brain, 6th edn, KG/EKG Press
- Houghton, AR and Gray, D (2014) - Making Sense of the ECG: A Hands-on Guide, 4th edn, Taylor and Francis
- Wagner, GS and Strauss, DG (2013) - Marriott's Practical Electrocardiography, 12th edn, LWW
- Goldberger, A (2006) - Clinical Electrocardiography: A Simplified Approach, 9th edn, Elsevier
- MedCram - Medical Lectures Explained Clearly (2017) - EKG / ECG Practice Strip Interpretation Explained Clearly - Case 10, (Accessed: 07/09/2019)
- Nurseledclinics (2011) - www.fastlearnecg.com : Simple reading and Interpreting of a 12-lead ECG (EKG) - Yes you can do it!, (Accessed: 10/09/2019)
- Osmosis (2019) - ECG Cardiac Hypertrophy | Osmosis, (Accessed: 07/09/2019)
- Osmosis (2019) - ECG Cardiac Infarction and Ischemia | Osmosis, (Accessed: 07/09/2019)
- Strong Medicine (2012) - Intro to EKG Interpretation - Bundle Branch Blocks, (Accessed: 02/09/2019)
- Strong Medicine (2012) - Intro to EKG Interpretation - Chamber Enlargement, (Accessed: 02/09/2019)
- USMLEVideoLectures (2008) - Most Important ECG Findings in Major Diseases, (Accessed: 28/06/2019)
- Miranda, DF et al. (2018) - New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department, Canadian Journal of Cardiology vol 34(2):132-145 (Accessed: 24/08/2019)
Groups of Signs
Variations: Hypertrophy and enlargement
This ECG is from a patient of unknown age who had a systolic BP of 220 mm HG and no ischemic symptoms.
This ECG shows tall QRS complexes meeting LVH criteria with anterior ST elevation. Echo confirmed marked left ventricular hypertrophy only.
Where did they come from?
These ECGs were collected from Free Open Access Medical Education (#FOAMed) blogs, with the permission of their authors. You can find out more about each ECG's source by clicking on it.
Why are they here?
This is an experiment in digital curation. The idea is to collect resources to increase awareness and accessibility. Over time, more ECGs in the collection will be tagged to make it easier to find them and reused in new interactive quizzes.
How can I use these ECGs?
You can use these ECGs for your own learning, teaching or research - as long as you abide by the terms of each ECG's copyright licence as stipulated by the original author.