Table 1

Commonly used criteria for ECG left ventricular hypertrophy (LV)

25–50% sensitive1-150
95% specific1-150
Chest lead
R wave in V5 or V6 exceeds 25 mm
S wave in V1 or V2 exceeds 25 mm
Tallest R wave in V5 or V6 + deepest S wave in V1 or V2 exceeds 35 mm
Ventricular activation time (onset of QRS to peak R) exceeds 0.04 s
Limb lead
R in aVL exceeds 11 mm
R in I exceeds 12 mm
R in aVF exceeds 20 mm
R in I + S in III exceeds 25 mm
R in aVL + S in V3 exceeds 13 mm
Repolarisation changes (see note)
Mildly abnormal:
 ST-T segment flattening, isolated ST depression or T wave inversion
Severely abnormal:
 ST depression with inverted or biphasic T waves
  • V4 to V6(that is, leads facing left ventricle)
  • 1 and aVL (facing left ventricle when heart horizontal) or
  • 11 and aVF (facing left ventricle when heart vertical)
Additional points
LVH results in only slight shift to the left of the frontal plane QRS axis
 Horizontal heart: axis = +30° to −30°
 Vertical axis: axis = +60° to +90°
There is often counterclockwise rotation—that is, qR complexes appear in the chest leads before the usual V4 to V6
Prominent u waves may be seen in the mid and right precordial leads in LVH
Remember digoxin can produce ST/T wave changes and u waves
  • 1-150 Vary with criteria used and population screened—see text.

  • Note: “strain” refers to the additionalpresence of ST/T wave changes, usually definite ST depression (1 mm) and T wave inversion or biphasic T wave, which are of particular prognostic importance in the presence ofvoltage changes—see text.