Today’s Morning Report is presented by Dr. Freedman!
The Case:
Left Ventricular Hypertrophy
Definition:
- increased mass of the left ventricle
How?:
- Things that cause increased afterload
HTN
Aortic Stenosis
Coarctation
- Genetics
HCOM
- Volume Overload?
Mitral Regurg
Aortic Regurg
Why do we care?
- risk of development of CAD
- risk of death
- Kannel et al, 1970
- ECG findings are characteristic and confusing
ECG findings of LVH
Basics:
- Thick-walled LV causes increased R wave amplitude in left-sided leads.
- Conversely, deep S waves in right-sided leads
- Thick-walls cause prolonged depolarization (increased time to peak of R) and abnormal repolarization (strain pattern?)
Voltage Criteria:
- There’s a billion
- Amal Mattu condenses them into
- S wave in V1 + R wave in V5-6 > 35mm
- Any S + any R > 45mm
- An R wave > 11mm in AVL
Non-Voltage Criteria
- Time to R wave peak > 50ms
- ST depressions and T wave inversions in lateral leads
- Characteristic morphology: ST depressions are diagonal and down-sloping
- Inverted T waves are very assymetric
NB* ECG criteria for LVH are only 50% sensitive!
Other findings commonly associated with LVH
- LAE
- LAD
- STE in right precordium
- U waves?!?!
LVH causes STE and ST Depressions!?!?!
How to distinguish LVH from STEMI?
- It’s not easy.
- Use caution
- Look out for horizontal ST depressions and symmetric inverted T waves.
When in doubt, get old and serial ecgs!
Have a low threshold to call cards.
Acknowledgements:
- http://ekgumem.tumblr.com/
- http://lifeinthefastlane.com/
- WILLIAM B. KANNEL, TAVIA GORDON, WILLIAM P. CASTELLI, JAMES R. MARGOLIS; Electrocardiographic Left Ventricular Hypertrophy and Risk of Coronary Heart DiseaseThe Framingham Study. Annals of Internal Medicine. 1970 Jun;72(6):813-822.
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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