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Chamber Hypertrophy and Enlargment: Difference between revisions

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Chamber Hypertrophy and Enlargment (view source)

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To diagnose left ventricular hypertrhophy on the ECG one of the following criteria should be met:
To diagnose left ventricular hypertrhophy on the ECG one of the following criteria should be met:
The '''Sokolow-Lyon criterium'''<cite>Sokolow</cite>), this is most often used:
The '''Sokolow-Lyon criterion'''<cite>Sokolow</cite>), this is most often used:
*R in V5 or V6 + S in V1 >35 mm.  
*R in V5 or V6 + S in V1 >35 mm.  


This criterium is not reliable below age 40 years.<cite>Chou</cite> In 10-29 year olds, the 99th percentile for SV1+RV5 is 53mm. In 20-39 year olds: 32% have SV2+RV5 > 35 mm.<cite>chou</cite> Correlation between LVH on ECG and echocardiography is low with ECG having a sensitivity of 27% and specicity of 88% for echocardiographically measured LVH<cite>echo</cite><cite>echo2</cite>. Moreover, both are independent estimators of worse prognosis.<cite>sundstrom</cite>.  
This criterion is not reliable below age 40 years.<cite>Chou</cite> In 10-29 year olds, the 99th percentile for SV1+RV5 is 53mm. In 20-39 year olds: 32% have SV2+RV5 > 35 mm.<cite>chou</cite> Correlation between LVH on ECG and echocardiography is low with ECG having a sensitivity of 27% and specificity of 88% for echocardiographically measured LVH<cite>echo</cite><cite>echo2</cite>. Moreover, both are independent estimators of worse prognosis.<cite>sundstrom</cite>.  


The '''Cornell-criterium''' has different values in men and women:
The '''Cornell-criterion''' has different values in men and women:
* R in aVL and S in V3 >28 mm in men
* R in aVL and S in V3 >28 mm in men
* R in aVL and S in V3 >20 mm in women
* R in aVL and S in V3 >20 mm in women


This is a better predicting criterium than the Sokolow-Lyon criterium, but less easy to remember, and therefore less often used.<cite>Levy</cite><cite>Sundstrom</cite>
This is a better predicting criterion than the Sokolow-Lyon criterion, but less easy to remember, and therefore less often used.<cite>Levy</cite><cite>Sundstrom</cite>


In the [[Romhilt-Estes Score]] LVH is ''likely'' with 4 or more points. LVH is ''present'' with 5 or more points.<cite>Romhilt</cite> Romhilt has reviewed ECG LVH criteria and gives an overview of the many LVH scoring systems. <cite>Romhilt2</cite> Left ventricular hypertrophy has prognostic consequences as has been found in several studies.<cite>Levy</cite><cite>Sundstrom</cite>
In the [[Romhilt-Estes Score]] LVH is ''likely'' with 4 or more points. LVH is ''present'' with 5 or more points.<cite>Romhilt</cite> Romhilt has reviewed ECG LVH criteria and gives an overview of the many LVH scoring systems. <cite>Romhilt2</cite> Left ventricular hypertrophy has prognostic consequences as has been found in several studies.<cite>Levy</cite><cite>Sundstrom</cite>
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Image:Extreme_lvh2.jpg|Another example of extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis.
Image:Extreme_lvh2.jpg|Another example of extreme left ventricular hypertrophy in a patient with severe aortic valve stenosis.
Image:extreme_lvh.jpg|ECG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.
Image:extreme_lvh.jpg|ECG of a patient with LVH and subendocardial ischemia leading to positive cardiovascular markers in blood testing.
Image:E0003191.png|LVH with repolarization changes as in this 12 lead ECG example has a worse prognosis than LVH without repolarization changes
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