In this example, the S wave in V1 = 24 and the R wave in V5 = 42 and total = 66, so criteria is met."Cornell Criteria"
In this example, the R in aVL = 20 and the S in V3 = 20 for total of 40 mm, so criteria is met for either a man or woman."aVL Criteria" (also by Sokolow and Lyons)There are other diagnostic criteria that are not listed here. Every set of criteria has a slightly different sensitivity and specificity when compared to echocardiography or autopsy criteria for LVH and no single criteria has yet been demonstrated to be superior.ST and T wave Changes:
When LVH is present, the ST and T waves are often abnormal. A term called "LVH strain" was commonly used to indicate that there was additional strain on the myocardium resulting in changes in the ST segment and T waves. The AHA recommnedations promote the use of the term "LVH with secondary ST-T wave abnormalities" instead of "strain"1. The ST and T wave changes are important to identify and characterize because they can cause diagnostic interference with ischemia and infarct (which also cause ST and T wave changes).There are 3 important "typical" features of ST-T wave abnormalities that are secondary to LVH include:
ST segments are concave upwards in V1-3.Less obviously, are concave downwards in V4-6.ST changes in LVH vs. Ischemia or InfarctionWith myocardial ischemia or infarction:
Summary of diagnostic criteria for LVH:
Increase your diagnostic accuracy: the following features are not required for the diagnosis of LVH, but if they are present, they increase the specificity of your diagnosis (in other words, make it more accurate):
In other words, an ECG that demonstrates voltage criteria plus LAD, ST - T wave changes, and LAE is more likely to be "truly LVH" compared to an ECG with the same voltage criteria without those extra features.1. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram Part 5. JAC. 2009;53(11):992–1002. doi:10.1016/j.jacc.2008.12.015.