Sections View Full Chapter Figures Tables Videos 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|Favorite Figure|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|Favorite Figure|Download Slide (.ppt) GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessEmergency Medicine 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessEmergency Medicine Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options