Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ ECG Findings ++ Largest R wave plus largest S wave in precordial leads > 45 mm R wave in V4, V5, V6 > 26 mm S wave in V1 + R wave in V5 or V6 > 35 mm R wave in aVL > 11 mm R wave in aVF > 20 mm S wave in aVR > 14 mm R wave in I + S wave in III > 25 mm ST depression and T-wave inversion in left-sided leads Left axis deviation +++ Pearls ++ LVH is often a sign of disease states such as systemic hypertension or aortic stenosis. ST elevations seen in LVH can be confused as myocardial ischemia. There are no clear criteria to distinguish the two; the clinical presentation is of essence, as well as comparison to old ECGs and serial ECGs. LVH may manifest on the ECG in many different ways. Several different systems for diagnosing LVH by ECG have been promoted (listed earlier), but none have been shown to be perfectly sensitive or specific. ++ FIGURE 23.38A Left Ventricular Hypertrophy with Strain Pattern. (ECG contributor: James V. Ritchie, MD.) Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 23.38B The QRS deflections are very large. The R wave in V5 plus the S wave in V1 total approximately 75 mm (arrows). ST downsloping to inverted T waves in V4 and V5 (arrowheads) may also be seen, a finding often referred to as “LVH with strain.” Graphic Jump LocationView Full Size||Download Slide (.ppt) Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.