Chamber enlargement

LVH –Cornell criteria R aVL + S V3 = 28 (male); 20 (female); 24 (other books) –Sokolov criteria R V5/6 + S V1 = 35 ( over 40 y.o); 40 (30-40 y.o.); 60 (16-30 y.o.) –Precordial leads Max R + S = 45 R V5 = 26 R V6 = 20 LVH –Limb Leads R Lead I + S II = 26 R Lead I = R aVL = S aVR = 15 R aVF =

Hierarchy of diagnosis –LBBB –WPW –LAFB –should be coded with axis deviation ST segment effect from LVH Confounders that reduce sensitivity –RVH –amyloid, sarcoid –pleural effusion –body habitus –COPD

Other changes of LVH –LAE –LAD –IVCD –intrinsicoid deflection > 50 ms –U waves –no Q waves

RVH –RAD –Dominant R wave R/S ratio V1, V3r > 1 R/S ratio V5/6 < 1 R wave V1 = 7 R V1 + S V5/6 = 11 qR in V1 –RAE, ST changes right precordial leads –Intrinsicoid deflection V1 < 40 ms Hierarchy/Confounder –Inferior/posterior MI –lateral MI –RBBB –LPFB –WPW –dextrocardia

Combined LVH + RVH –LVH + RAD –LVH + Q aVR + R in V5 + T wave inversion in V1 –Large R = S in V3 and V4 (Kutz-Wachtel) –LVH + RAA

RAA –Tall P wave 2.5 mm in II, III, aVF –tall P wave 1.5 mm in V1, V2 –P axis > 70° –Think, COPD, TOF, Eisenmenger, PE, RVH. LAA –Biphasic P wave, terminal inverted > 40 ms in V1 –notched P wave > 120 ms in II, III, aVF –Think, MS, MR, AS, AI, CHF, LVH