Signs of left ventricular hypertrophy on an ECG:
- The averaged segment of the ventricular complex shifts forward and to the right relative to its standard position.
- Excitement, going from the inner lining of the heart to the outer, is growing.
- The range of oscillations of the R wave increases in the left leads (I, aVL, V5 and V6).
- With a pronounced pathology, the following picture is observed: the R waves are located higher, and the S waves fall deeper.
- The transition zone has a clear deviation in the leads V1 or V2.
- The ST portion is located below the horizontal portion of the segments, which reflect the absence of potential difference on the surface of the body.
- LDLH conductivity is impaired or complete (incomplete) blockade of this leg is observed.
- Having arisen in one area of the myocardium, the excitation can spread to its other areas, but in this case this process is disrupted.
- EOS (electrical axis of the heart) deviates to the left.
- EOS acquires a semi-horizontal or horizontal position.
To identify another pathology – left ventricular hypertrophy on an ECG, special attention is paid to the P wave, which indicates the excitation of two atria. The part of the P wave that is responsible for the excitation of the right atrium corresponds to the norm, and the part that reflects the excitation of the left atrium in a hypertrophic state has an increased amplitude of oscillations and their duration. The normal thickness of the wall of the left ventricle is 2 times greater than the right and is 10-12 mm.
With severe LVH, the thickness of the overgrown tissue is more than 25 mm
ECG for left ventricular hypertrophy
An enlarged left ventricle (LV) spends more time on stimulation and contraction. Accordingly, on the ECG this will manifest itself with certain signs. On the electrocardiogram, signs of left ventricular hypertrophy (LVH) will be recorded in the left chest leads, which include V5 and V6.
Not only the left, but also the right chest leads (V1 and V2) will have signs indicating an increase in the left departments. Today, there are many diagnostic criteria for LVH, but not one of them has 100 percent accuracy and reliability. For the accuracy of the diagnosis, it is necessary to take into account not only a combination of symptoms, but also the addition of nonfunctional diagnostic data. Here are the most commonly used criteria:
In the left chest leads, changes are also noticeable, which may indicate the presence of LVH:
- Maximum height R in V5, V6. Normally, the maximum R should be in V4. In V4, V5 or V6, the R wave is more than 26 mm.
- For greater accuracy, the Sokolov-Lyon index is used, according to which the sum R V5 is calculated either in V6 and S in V1. The diagnostic sign of LVH is the sum of the teeth more than 35 mm.
- The Cornell Index is also used to diagnose LVH. The amplitude R in lead aVL is calculated with the amplitude S in lead V3. The amount in men is more than 28 mm, and in women more than 20 mm indicates a possible LVH.
- The sum of the highest amplitude R wave with the deepest S wave in the chest leads greater than 35 mm indicates left ventricular hypertrophy.
- Depression of the ST segment and inversion of T in V5, V6, indicating LV overload.
- ST segment elevation in the chest leads V1, V2, V3.
Right ventricular hypertrophy (RV) is less common than left ventricular hypertrophy. Signs of an increase in the pancreas on the ECG will be recorded in the right chest leads. Characteristic changes in pancreatic enlargement will be recorded in leads III, aVF, V1, V2. Signs of pancreatic hypertrophy are as follows:
Even less frequently, an electrocardiogram shows an increase in two heart chambers simultaneously. Often, an increase in the pancreas is not visible due to the fact that signs of left ventricular hypertrophy overlap it. There may be the following ECG signs:
- A combination of LVH signs with a simultaneous deviation of the electrical axis of the heart to the right.
- A combination of signs of an increase in the pancreas and a deviation of the electrical axis of the heart to the left.
- The high R wave in V5, V6, as well as the high R wave over 7 mm in V1, V2.
- If there are signs of an increase in the pancreas, there is no S wave in V5-6.
- The combination of left ventricular hypertrophy with incomplete blockade of the right bundle branch block.
Today, there is a great opportunity to make a diagnosis using echocardiography, which does not violate the integrity of the body. It is only necessary to install the sensor on the surface of the patient’s chest to obtain information about the state of his cardiovascular system. Therefore, in obscure cases, the latter method is indispensable in making the correct diagnosis.
Signs of LVH can be quite diverse. In many ways, the signs of left ventricular hypertrophy depend on the specific cause of the disease, the stage and neglect of the disease.
Some forums claim that the disease did not make itself felt for a long time, right up to the development of dangerous complications. However, other patients indicate an acute course of the disease.
There are such traditional signs of LVH:
- Frequent pain in the heart indicates aortic and muscle failure, as well as overload of the myocardial valve. In this case, the pain will be sharp, suddenly arising and constricting.
- Unstable heart rate.
- Frequent changes in blood pressure (severe hypertension).
- Shortness of breath and difficulty in breathing.
- Severe angina pectoris and amplitude cardiomyopathy.
- Weakness and disability.
- Soreness localized in the chest.
- Often occurring headaches as a direct consequence of the ailment.
- Rapid muscle fatigue.
In addition, signs of left ventricular hypertrophy can be expressed in fainting, which is caused by a sharp violation of blood circulation in the heart and its mitral septa.
In this state, the heart muscle experiences oxygen starvation and malfunctions in rhythm.
Moreover, with poor blood supply, a person may develop heart disease or heart attack.
Signs of left ventricular hypertrophy are quite specific for different forms of the disease and may differ slightly from each other.
The main danger of LVH lies in the fact that with such a disease in humans, the risk of developing myocardial infarction, various heart defects and its sudden stopping sharply increases. Also, with hypertrophy, a sudden rupture of the ventricle in the myocardium can occur, which can be fatal.
In addition to signs of left ventricular hypertrophy, doctors distinguish two forms of cardiomyopathy that occur with LVH:
- Hypertrophic form.
- Dilatation form.
The hypertrophic form of the disease on the electrical cardiogram is quite noticeable. The most clearly visible change in the size of the heart and high Rv wave. The dilated form usually does not affect the ventricle very much. Usually, stenosis is seen around the longitudinal axis, and there is also a discharge of the left atrium.
Signs of left ventricular myocardial hypertrophy can develop spontaneously or vice versa, last quite a long time, gradually increasing. In this case, patients should know that when the first signs of LVH appear, the patient needs to contact a cardiologist and conduct a detailed diagnosis as soon as possible. This is justified by the fact that the sooner treatment therapy is started, the greater the person’s chance of a speedy recovery.
How is the left ventricular hypertrophy reflected on the ECG
What is left ventricular hypertrophy has already been noted, it is now important to understand how this disease is displayed on the cardiogram. In order to recognize the signs of hypertrophy on electrocardiography, you need to pay attention to the teeth, segments and complexes. So, it is possible to diagnose such a disease in the presence of the following anomalies on the ECG:
- in leads V5 and V6 there is a high R clove;
- in leads V1 and V2, an elevated S wave can be recognized;
- in the chest lead V1, the T wave is more important than in the lead V6;
- The ST segment in V5 is below the isoline;
- the amplitude of the T wave is increased, as well as the ST segment;
- in leads V5 and V6 T is characterized by asymmetry and a negative indicator;
- in lead V1 and V2, the location of the ST segment is defined below the isoelectric line.
In addition to all of the above, it is worth noting that such an ailment on the electrocardiogram can be determined by the movement of the transition zone to the right-side chest leads.
Causes of LVH
Left ventricular hypertrophy (LVH) occurs against the background of such diseases and conditions. Arterial hypertension – in this case, the myocardium begins to thicken due to the increased rhythm of blood pumping, which can not be avoided even with mild forms of hypertension, not to mention a stable increase in blood pressure and hypertensive crises.
Heart defects – this can include: mitral valve defect, aortic valve pathology, pulmonary valve pathology, oval hole defect. For a long time, such pathologies do not make themselves felt and there is no additional symptomatology, so LVH on the ECG is the main symptom. Hypertrophic type cardiomyopathy – the essence of the disease is a violation of the normal change of systole and diastole. And also with this pathology, muscle fibers have a chaotic location in the myocardium.
Coronary artery disease. CHD includes organic and functional changes in the muscle associated with a sharp restriction or complete cessation of blood supply to individual sites.
The next reason is atherosclerosis of the heart valves. With this pathology, the hole in the left chamber narrows, with which a large circle of blood circulation begins. Most often, atherosclerosis of heart valves affects elderly people.
Increased physical activity – LVH can develop at a young age among those who are actively involved in sports. This is due to the fact that against the background of serious stresses, the heart muscle significantly increases in mass and volume. A moderate form of hypertrophy is not life threatening and is often observed in those who are professionally involved in sports and other people who are subjected to high physical exertion.
An enlarged heart muscle loses its elasticity over time
Diagnosis of hypertrophy
The disease has several degrees of development, respectively, ECG signs of left ventricular hypertrophy at different stages will differ. The first stage of the disease is characterized by a high amplitude of QRS, a positive value of the T wave, and the absence of ST segment displacement.
The manifestation of the disease on an electrocardiogram
As for the second stage of the disease, it is already characterized by more serious changes, which can be manifested by a significant increase in the amplitude of the QRS complex, a decrease in the T wave, and also an insignificant plane of its shape. In addition, at the second stage, an offset of the ST segment of the discordant type is traced.
The third degree of the disease is also characterized by an increase in QRS complex, while it can be quite pronounced. There is also a discordant displacement not only of the ST segment, but also of the T wave, the displacement occurs in relation to the QRS complex.
The fourth stage of the disease is considered to be the most complex and pronounced, respectively, on the cardiogram it is displayed by pronounced and serious changes. At the fourth stage of hypertrophic damage, a decrease in the amplitude of QRS of a secondary nature can be traced. In addition, repolarization disorders occur, which are also characteristic of the third stage of the disease.
In addition to LVH, a pathology such as left atrial hypertrophy, which is also quite pronounced on the electrocardiogram, can occur.
Cardiogram indices for left atrial hypertrophy
Hypertrophy of the left atrium on the ECG is manifested by a large number of changes that are associated with different parts of the heart. Special attention should be paid to the changes that occur with the P6 wave:
- it becomes wide and, as a rule, two-humped;
- amplitude increases;
- the duration of the second part increases;
- the height becomes larger;
- Notches may appear at the top.
An experienced specialist on the results of ECG will be able to recognize the symptoms of the disease
It is important to note that pathological changes in the P wave can be traced in different leads, namely, the two-humped tooth can be recorded in 1, 2, V6, V5 and aVL. In aVR, it is often negative.
That is, the signs of such a disease can be determined by an experienced specialist without much difficulty, the main thing to consider is that the manifestations of hypertrophic lesions of the left ventricle can be caused both by the disease itself and by such a deviation as dilatation. Very often, a combination of these two pathologies occurs in patients.
Important! A cardiogram is the main diagnostic method for diagnosing hypertrophic lesions. Accordingly, without undergoing such an examination, an accurate diagnosis cannot be established.
In most cases, to determine the hypertrophic lesion does not need a lot of time, as already noted, the symptoms of pathology on the ECG are very pronounced. But there is a chance to confuse this ailment with other cardiac pathologies, which is why in case of doubt, the patient may be prescribed ventriculography or echocardiography.
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