Lvh & rvh

LVH & RVH on ECG

1. LVH AND RVH Dr. Mohammed Niyaz MEM Y2 ASTER MIMS

2. OVERVIEW LVH Definition Types of LVH ECG changes in systolic overload Criteria to diagnose LVH ECG changes in diastolic overload RVH Definition ECG changes Clinical correlation

3. Definition of lvh Increase in the mass of the left ventricle, which can be secondary to an increase in wall thickness, an increase in cavity size, or both.

4. The normal qrs through the leads

5. Represents dominant right to left QRS vector Indirect representation of left free wall activation Hypertrophy of LV free wall Left Ventricular Hypertrophy

6. Systolic overload aka Pressure overload Resistance to LV systolic outflow LV compromise occurs in systole AS, HTN, HCM, Coarctation of aorta Diastolic overload aka Volume overload Overfilling of the LV in diastole LV compromise occurs in diastole PDA, VSD ( moderate to large L  R shunts ), AR, MR Left Ventricular Hypertrophy

7. LVH due to systolic overload

8. Abnormalities of QRS & T wave axis

9. QRS T wave Axis Early stage – no change in axis Due to symmetric increase in bulk Late stage- Left Axis deviation Due to left anterior hemiblock

10. Romhilt and Estes point score system ECG finding Point s Increased QRS magnitude 3 ST T abnormalities 3 P wave of LA abnormality 3 Left axis deviation 2 Increased V AT 1 ≥ 5points  LVH Mainly applicable for LVH due to systolic overload

11. SOKOLOW LYON INDEX

12. Total QRS voltage of all 12 conventional ECG leads > 175 mm or 17.5 mV TOTAL QRS VOLTAGE

13. CORNELL VOLTAGE CRITERIA

14. R wave in aVL > 11 mm

15. LVH due to diastolic overload

16. Clinical significance of LVH

17. LV strain T inversion Ischemic T inversion

18. RIGHT VENTRICULAR HYPERTROPHY

19. Right Ventricular Hypertrophy Paraseptal region Free wall of RV Basal regions

20. QRS manifestations

21. Right axis deviation R in V1 > 6 mm qR complex in V1 (R in V1) + (S in V5 or V6) > 10.5 mm R/S ratio in V1 >1 S/R ratio in V6 >1 Increased VAT in V1 Right bundle branch block ST-T wave abnormalities ("strain") in right precordial leads Right atrial  abnormality S1S2S3 pattern S1Q3T3 pattern

22. SI SII SIII SYNDROME

23. Clinical correlation

24. BIVENTRICULAR HYPERTROPHY

25. TAKE HOME MESSAGE DIAGNOSING LVH SOKOLOV LYON CRITERIA VOLTAGE IN aVL NON VOLTAGE CRITERIA CLINICAL CORRELATION DIAGNOSING RVH

26. Thank you