Welcome to Day 27! Today, we’ll dive into the fascinating world of Ventricular Hypertrophy (VH). VH occurs when the heart’s ventricles become thickened. Understanding LVH (Left Ventricular Hypertrophy) and RVH (Right Ventricular Hypertrophy) on an ECG is crucial for identifying patients at risk of heart failure, arrhythmias, and sudden cardiac death. Let’s get started! ❤️

Learning Objectives 🎯

• 💡 Define Left Ventricular Hypertrophy (LVH) and Right Ventricular Hypertrophy (RVH).
• 📝 Identify ECG criteria for LVH.
• 📈 Identify ECG criteria for RVH.
• 🫀 Understand the clinical significance of LVH and RVH.

Left Ventricular Hypertrophy (LVH) 🫀

LVH is an increase in the thickness of the left ventricular myocardium. It’s often a response to chronic pressure or volume overload, such as hypertension or aortic stenosis. On the ECG, we look for specific voltage criteria and associated ST-segment and T-wave changes.

Sokolow-Lyon Criteria 📏

The most commonly used criterion is the Sokolow-Lyon Index:

S wave in V1 + R wave in V5 or V6 (whichever is larger) > 35 mm (3.5 mV)

Note: This criterion has good specificity but lower sensitivity.

Cornell Voltage Criteria 📐

Another voltage criterion is the Cornell voltage:

R wave in aVL + S wave in V3 > 28 mm in men, > 20 mm in women

Strain Pattern (ST-T wave changes) 💔

LVH often presents with a “strain pattern,” consisting of ST-segment depression and T-wave inversion in the lateral leads (I, aVL, V5, V6). This pattern suggests significant hypertrophy and increased risk.

Right Ventricular Hypertrophy (RVH) 💪

RVH is the enlargement of the right ventricle, usually due to increased pulmonary pressure, as seen in conditions like pulmonary hypertension or chronic lung disease (cor pulmonale). ECG findings in RVH can be more subtle than in LVH.

ECG Criteria for RVH 📈

• R wave in V1 > 7 mm
• R/S ratio in V1 > 1
• Dominant R wave in V1, V2
• Right axis deviation (often > +110 degrees)
• Strain Pattern (ST-T wave changes) in inferior leads (II, III, aVF)

P Pulmonale 🌬️

In RVH secondary to lung disease, you might also see “P pulmonale” – tall, peaked P waves, especially in the inferior leads.

Clinical Significance 🩺

Both LVH and RVH are associated with increased cardiovascular risk. Identifying these conditions early allows for appropriate management and intervention to prevent further complications. They can be indicators of underlying conditions requiring further investigation.

Quiz Time ❓

1. Which of the following is a voltage criterion for LVH?
   A. R wave in V1 > 7 mm
   B. S wave in V1 + R wave in V5 or V6 > 35 mm (Correct)
   C. Q wave in I, aVL, V5, V6
2. What ECG finding is often associated with LVH and is called a “strain pattern”?
   A. Peaked T waves
   B. ST-segment elevation
   C. ST-segment depression and T-wave inversion (Correct)
3. Which of the following is an ECG criterion for RVH?
   A. S wave in V1 + R wave in V5 or V6 > 35 mm
   B. R/S ratio in V1 > 1 (Correct)
   C. Deep S waves in V5 and V6
4. What condition is RVH often associated with?
   A. Aortic stenosis
   B. Pulmonary hypertension (Correct)
   C. Mitral valve prolapse
5. What does the Sokolow-Lyon criteria measure?
   A. RVH voltage

   B. Axis Deviation

   C. LVH voltage (Correct)

Summary 📝

Today, we explored the ECG criteria for LVH and RVH. Remember the voltage criteria (Sokolow-Lyon, Cornell, R wave amplitude), strain patterns, and associated findings like right axis deviation and P pulmonale. Identifying these patterns can help you recognize patients at risk and guide further evaluation.

Review and Practice 👨‍⚕️👩‍⚕️

Review the ECG criteria discussed today. Practice identifying LVH and RVH on ECG strips. Look for examples online or in textbooks.

Next Day Preview 🗓️

Tomorrow, we will be looking at atrial abnormalities – specifically Left and Right Atrial Enlargement.

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