Ventricular Hypertrophy

LVH with strain

• Voltage criteria for LVH
• Left atrial enlargement
• Left axis deviation
• Subtle QRS widening (0.11 - 0.13 s)
• Repolarization abnormality (strain pattern or any other ST-T abnormality)
• Definition of strain pattern: “Upward convex ST depression followed by non-symmetrical T wave inversion (shallow downslope, rapid upslope) in leads with upright QRS complexes”
• “Mirror image” strain pattern may cause ST elevation in V1-V2
• ECG evaluation for “coronary ischemia” is limited in the presence of LVH with strain

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RVH

• Common but less specific findings: frequently reflects pulmonary hypertension
• Right atrial enlargement
• Right axis deviation
• R/S ratio in V1 >1
• R/S ratio in V6 <1
• qR complex in V1
• Inverted T waves in V1-V3
• Inverted T waves in the inferior leads
• Uncommon finding but highly specific for severe RVH
  • QRS narrow but upgoing in V1
  • QRS in V1 may start with a narrow Q wave (qR pattern)
  • ST segment depressed and T wave inverted in V1-V2 (strain pattern)

Pulmonary Embolism

Pulmonary Disease