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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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[[Image:E_lvh.jpg|thumb|right|300px|LVH. R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.]] | [[Image:E_lvh.jpg|thumb|right|300px|LVH. R in V5 is 26mm, S in V1 in 15mm. The sum is 41 mm which is more than 35 mm and therefore LVH is present according to the Sokolow-Lyon criteria.]] | ||
[[Image:LVH.png|thumb|250px]] | [[Image:LVH.png|thumb|250px]] | ||
As the left ventricular wall becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a 'strain pattern'. | As the left ventricular wall becomes thicker, the QRS complexes become larger. This is especially true for leads V1-V6. The S wave in V1 is deep, the R wave in V4 is high. Often some ST depression can be seen in leads V5-V6, which is in this setting is called a 'strain pattern'. | ||
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 | 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 | 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- | 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 | 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> | ||
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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==Example== | ==Example== | ||
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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 | |||
</gallery> | </gallery> | ||
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