ECG Review
Is There LVH?
By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida; Dr. Grauer is the sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.
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Scenario: The ECG in the Figure above was obtained from a 45-year-old woman without previous health care, who presented to the office with heart failure. There were no previous records, and no prior tracing available for comparison. How would you interpret her ECG? Is there left ventricular hypertrophy (LVH)?
Interpretation: The rhythm in this tracing is sinus tachycardia at a rate of about 115/minute. Intervals appear normal, and the mean QRS axis is +40°. The tall pointed P wave in lead II is consistent with the P pulmonale pattern of RAE (right atrial enlargement), and the deep negative component to the P wave in lead V1 with LAE (left atrial enlargement). However, ECG voltage criteria for LVH (left ventricular hypertrophy) are not met. The deepest S wave in leads V1,V2 plus tallest R in V5,V6 falls shy of 35 mm; the R in lead aVL is nowhere near 12 mm; and no other voltage criteria for LVH are satisfied. That said, the ST-T wave appearance in lateral lead V6 is clearly suggestive of a left ventricular "strain" pattern. Non-specific ST-T wave flattening is seen in a number of other leads.
Published ECG criteria for LVH are lacking in both sensitivity and specificity. The specificity of criteria for LVH can be improved by taking into consideration the clinical situation and by the finding of ST-T wave abnormalities consistent with "strain." Thus, even though ECG criteria for LVH are not met in this tracing, the finding of biatrial enlargement (LAE and RAE) in a clinical setting of heart failure that occurs in conjunction with ST-T wave abnormalities consistent with "strain" make it likely that true left ventricular chamber enlargement is present in this patient. The constellation of multichamber enlargement with tachycardia and ST-T wave abnormalities as are seen here should suggest a clinical diagnosis of cardiomyopathy.
The ECG in the Figure above was obtained from a 45-year-old woman without previous health care, who presented to the office with heart failure. There were no previous records, and no prior tracing available for comparison. How would you interpret her ECG? Is there left ventricular hypertrophy (LVH)?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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