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.
See also: Hypertrophy and enlargement
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- Hampton, J and Hampton, J (2019) - The ECG Made Easy, 9th edn, Elsevier
- Thaler, MS (2018) - The Only EKG Book You'll Ever Need, 9th edn, Lippincott Williams and Wilkins
- 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)