LVH

Left ventricular hypertrophy (LVH) causes a tall QRS. There are various criteria for LVH. Diagnosis requires voltage and non-voltage criteria to be met.

Voltage Criteria

  • 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

Non Voltage Criteria

  • 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.

See also: Hypertrophy and enlargement

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In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST elevation Tall QRS LVH Dr Smith's ECG Blog CC BY-NC
Profound ST Elevation in V1-V3. What do you think?

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.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST elevation Inferior ST depression Reciprocal ST depression ST elevation in aVL ST elevation in aVR Tall QRS LVH Dr Smith's ECG Blog CC BY-NC
Syncope, History of Coronary Disease, and ST Elevation: Should Medics Activate the Cath Lab?
In the ECGquest archives, this ECG has been tagged with: - 12-Lead Anterior ST elevation Inferior ST depression Reciprocal ST depression ST elevation in aVL ST elevation in aVR Tall QRS LVH Dr Smith's ECG Blog CC BY-NC
Syncope, History of Coronary Disease, and ST Elevation: Should Medics Activate the Cath Lab?
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Discordant ST changes Tall QRS LVH Dr Smith's ECG Blog CC BY-NC
Chest Pain and ST Elevation on the Monitor – repeat ECG in ED
In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Concordant ST elevation Inverted T waves Narrow QRS RSR' Tall QRS Incomplete RBBB LVH Dr Smith's ECG Blog CC BY-NC
Unusual ST Elevation in V1 and V2, and LVH, in a Patient with Chest Pain