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8. Ventricular Hypertrophy

Topics for study:

  1. Introduction
  2. Left Ventricular Hypertrophy (LVH)
  3. Right Ventricular Hypertrophy (RVH)
  4. Biventricular Hypertrophy


Introductory Information:

The ECG criteria for diagnosing right or left ventricular hypertrophy are very insensitive (i.e., sensitivity ~50%, which means that ~50% of patients with ventricular hypertrophy cannot be recognized by ECG criteria). However, the criteria are very specific (i.e., specificity >90%, which means if the criteria are met, it is very likely that ventricular hypertrophy is present).

Left Ventricular Hypertrophy (LVH)

General ECG features include:

ESTES Criteria for LVH

("diagnostic", ≥ 5 points; "probable", 4 points)

+ECG Criteria Points
Voltage Criteria (any of):
  • R or S in limb leads ≥ 20 mm
  • S in V1 or V2 ≥ 30 mm
  • R in V5 or V6 ≥ 30 mm
3 points
ST-T Abnormalities:
  • Without digitalis
  • With digitalis
3 points
1 point
Left Atrial Enlargement in V1 3 points
Left axis deviation 2 points
QRS duration 0.09 sec 1 point
Delayed intrinsicoid deflection in V5 or V6 (>0.05 sec) 1 point

CORNELL Voltage Criteria for LVH

(sensitivity = 22%, specificity = 95%)

Other Voltage Criteria for LVH:

Right Ventricular Hypertrophy

General ECG features include:

Specific ECG features (assumes normal calibration of 1 mV = 10 mm):

Example #1: (note RAD +105 degrees; RAE; R in V1 > 6 mm; R in aVR > 5 mm)

image 11-05

Example #2: (more subtle RVH: note RAD +100 degrees; RAE; Qr complex in V1 rather than qR is atypical)

image 11-14.2

Example #3: (note: RAD +120 degrees, qR in V1; R/S ratio in V6 < 1)

image 11-14.5

Biventricular Hypertrophy (difficult ECG diagnosis to make)

In the presence of LAE any one of the following suggests this diagnosis:

Other suggestive ECG findings:

Test your knowledge on lessons 7 and 8!