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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


  1. LVH is often a sign of disease states such as systemic hypertension or aortic stenosis.

  2. 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.

  3. 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.


Left Ventricular Hypertrophy with Strain Pattern. (ECG contributor: James V. Ritchie, MD.)


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.”

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