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left ventricular hypertrophy (LVH)

Etiology: - generally results from chronic hypertension - LVH despite normal blood pressure suggests masked hypertension Pathology: - associated with LV diastolic dysfunction - associated with 5-14% risk of LV systolic dysfunction [2] Genetics: - polymorphism in ANF receptor type A gene associated with left ventricular hypertrophy & decreased serum atrial natriuretic factor [4] Special laboratory: - electrocardiographic (ECG) criteria: a) tall left precordial R waves, deep right precordial S waves b) Sokolow-Lyon criteria - S in V1 + R in V5 or V6 > 35 mm - R in V5 or V6 > 26 mm c) Cornell criteria - R in aVL + S in V3 > 20 mm (female) - R in aVL + S in V3 > 28 mm (male) d) Casales criteria - R in aVL + S in V3 > 35 mm (male) 25 mm (female) - R in aVL + S on V3 > 22 mm (male) 12 mm (female) + T > 0 mm (< 40 years) > 2 mm (> 40 years) e) Romhilt-Estes scoring system - R or S in any limb lead > 20 mm, or S in lead V1 or V2 > 30 mm, or R in lead V5 or V6 > 30 mm: (3 pts) - left ventricular strain, ST segment & T wave in opposite direction to QRS - ST segment depression bowed upward & T wave inversion - no digitalis: (3 pts) - + digitalis: (1 pt) - left atrial enlargement: (3 pts) - left axis deviation < -30 degrees: (2 pts) - QRS duration > 90 ms: (1 pt) - intrinsicoid deflection in lead V5 or V6 > 50 ms: (1 pt) - total: 13 pts - > 4 points = LVH - left ventricular hypertrophy identified by ECG does not warrant an echocardiogram [9] *Caution: LVH cannot be assessed in the presence of left bundle branch block (LBBB) Management: - left ventricular hypertrophy with normal blood pressure suggests masked hypertension & warrants ambulatory blood pressure monitoring [5,6]

Related

right ventricular hypertrophy (RVH)

General

ventricular hypertrophy

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Figures/diagrams/slides/tables related to left ventricular hypertrophy

References

  1. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1240
  2. Journal Watch 24(16):127, 2004
    1. Drazner MH, Rame JE, Marino EK, Gottdiener JS, Kitzman DW, Gardin JM, Manolio TA, Dries DL, Siscovick DS. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol. 2004 Jun 16;43(12):2207-15. PMID: 15193681 - Frohlich ED. Left ventricular hypertrophy: a 'factor of risk': mass is reversible, but is the risk? J Am Coll Cardiol. 2004 Jun 16;43(12):2216-8. No abstract available. PMID: 15193682
  3. Journal Watch 25(1):1, 2005 Okin PM, Devereux RB, Jern S, Kjeldsen SE, Julius S, Nieminen MS, Snapinn S, Harris KE, Aurup P, Edelman JM, Wedel H, Lindholm LH, Dahlof B; LIFE Study Investigators. Regression of electrocardiographic left ventricular hypertrophy during antihypertensive treatment and the prediction of major cardiovascular events. JAMA. 2004 Nov 17;292(19):2343-9. PMID: 15547161 - Devereux RB, Wachtell K, Gerdts E, Boman K, Nieminen MS, Papademetriou V, Rokkedal J, Harris K, Aurup P, Dahlof B. Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA. 2004 Nov 17;292(19):2350-6. PMID: 15547162
  4. Rabattu S et al, Association of atrial natriuretic peptide and type A natriuretic peptide receptor gene polymorphisms with left ventricular mass in human essential hypertension. J Am Coll Cardiol 2006, 48:499 PMID: 16875975 - London B, Natriuretic peptides and cardiac hypertrophy J Am Coll Cardiol 2006, 48:506 PMID: 16875976
  5. Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  6. Cuspidi C, Negri F, Sala C, Mancia G. Masked hypertension and echocardiographic left ventricular hypertrophy: an updated overview. Blood Press Monit. 2012 Feb;17(1):8-13 PMID: 22183044
  7. Bauml MA, Underwood DA Left ventricular hypertrophy: an overlooked cardiovascular risk factor. Cleve Clin J Med. 2010 Jun;77(6):381-7. PMID: 20516249 Free article
  8. Bacharova L, Schocken D, Estes EH, Strauss D. The role of ECG in the diagnosis of left ventricular hypertrophy. Curr Cardiol Rev. 2014 Aug;10(3):257-61 PMID: 24827796 PMCID: PMC4040877 Free PMC article
  9. Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022