Signs of left ventricular myocardial hypertrophy on ECG

Hypertrophy of the heart, or, in other words, hypertrophic cardiomyopathy is a thickening of the wall of the left ventricle of the heart, which leads to malfunctioning of the aortic valve. The problem is common among hypertensive patients, as well as athletes, people with a sedentary lifestyle, addicted to alcohol and those who inherited a tendency to pathology.

Myocardial hypertension of the left ventricles of the heart belongs to class 9 on the ICD 10 scale, together with other diseases of the circulatory system. This pathology is mainly a syndrome of other heart diseases, the indirect signs of which are manifested. In order to prevent possible problems in the future, it is necessary to intensively treat a hypertrophied organ in a timely manner, immediately after the detection of pathologies.

Depending on the signs of LVH and the size of the deformed muscle tissue, several stages of the development of the disease can be distinguished:

Moderate left ventricular hypertrophy (LVH) occurs as a result of hypertension or other heart diseases. This seemingly insignificant increase signals a heart overload and that the risk of myocardial diseases (heart attack, stroke) for the patient increases. It often proceeds without any signs, it is detected only when analyzing the ECG. If the left ventricle is enlarged, it is necessary to be treated with the help of specialists, best of all – stationary.

Pronounced LVH is characterized by dystrophic changes, in which the mitral valve is located close to the surface of the septum and interferes with the flow of blood, causes excessive muscle tension and stress on the left ventricle.

The causes of left ventricular hypertrophy of the heart can be varied, among them both chronic and acquired diseases of different parts of the body:

  • hypertension;
  • obesity: the development of an ailment in young children who are overweight is very dangerous;
  • ischemia;
  • diabetes;
  • arrhythmia, atherosclerosis;
  • frequent excessive physical exertion;
  • alcoholism, smoking;
  • high blood pressure;
  • lung diseases;
  • aortic stenosis;
  • abnormalities of the mitral valve;
  • stress, psychological illness, nervous exhaustion.

The development of the body in a child can occur with a violation of the processes of myocardial repolarization and, as a result, an increase in the walls of the ventricle. If such a situation arose, it must be prevented, and in the future to observe stationary during adulthood and not allow progression. Continuous exercise can naturally lead to heart enlargement, while work related to weight lifting is a potential threat to systolic overload, so you should normalize your physical activity and monitor your health.

Another indirect reason is sleep disturbance, in which a person stops breathing for a short period of time. It can be observed in women during menopause or in the elderly and entails consequences such as expansion of the diameter of the vessels of the heart, growth of the septum and walls of the heart, increased blood pressure, arrhythmia.

If the left ventricle is hypertrophied – this is not a disease, but it can provoke a lot of them in the future, including death of heart attacks, strokes, angina pectoris and other heart ailments. Often, organ enlargement occurs due to an active lifestyle, in athletes, when the heart works harder than in the average body. Such changes may not pose a threat, but in each case, qualified consultation and advice from a doctor is necessary.

Many people are prone to heart hypertrophy. If the problem is severe, drug or surgical treatment of left ventricular hypertrophy is performed. Moreover, depending on the degree of damage, treatment can be aimed at preventing the progression of the disease or returning the myocardium to normal size boundaries. But it happens that this condition is reversible, if the ailment cannot be completely cured, then regression can be achieved by correcting such things as:

  • Lifestyle;
  • type of food;
  • hormonal balance;
  • excess weight;
  • amount of physical activity.

Medicines for hypertrophy of the left ventricle of the heart can have an effective result if taken under the supervision of a doctor. It is impossible to completely eliminate the symptoms of hypertension, however, taking antihypertensive drugs with this disease and following a diet will help to deal with the causes and prevent health deterioration. To cure LVH, prescribe these drugs:

Verapamil is an angiarrhythmic agent from the group of calcium channel blockers. Reduces myocardial contractility, reduces heart rate. It can be used by both adults and children, the doses are set individually.

Beta-blockers – reduce the load of pressure and volume in the heart cavity, help to even out the rhythm and reduce the risk of defect.

Sartans – effectively reduce the overall load on the heart and remodel the myocardium.

Myocardial hypertension of the lying heart belongs to class 9 on the ICD-10 scale, along with other diseases of the circulatory system. Preference should be given exclusively to drugs whose quality has been tested and proven clinically, experimental drugs can not only not have the expected effect, but also adversely affect overall health.

Surgery for left ventricular hypertrophy may be needed to remove a hypertrophied muscle area in the late and advanced stages of the disease. For this, a transplant of the whole heart or its individual parts is carried out. If the cause of LVM is damage to the valve or septum, an attempt is first made to transplant specifically these organs, which is simpler than whole heart surgery.

Treatment of left ventricular hypertrophy of the heart with folk remedies cannot help in the late stages of lesions, but it can be effective with slight increases to prevent their development and reduce the risk of more serious consequences. You can not completely cure the ailment, but traditional medicine can relieve discomfort, chest pain, weakness and fainting. Known tools are:

Herbal preparations as adjunctive therapy for the main treatment (blueberries, motherwort, marshmallow hawthorn, horsetail, cornflower flowers, adonis)

Infused milk: boil and pour overnight in a thermos, or put in the oven until a brown crust forms.

Lily of the valley in the form of drops of tincture or gruel. For tincture, pour lily of the valley with vodka or alcohol, insist in a dark place for 2 weeks, take 10 drops 3 times a day for 2 months. Porridge: pour lily of the valley flowers with boiling water, insist 10 minutes. Then drain the water, grind the plant and take a tablespoon 2 times a day. It is recommended in combination with drops.

Garlic honey: crushed garlic mixed with honey in the proportions 1: 1, insist a week in a dark place, take 1 tablespoon 3 times a day before meals.

Dry red wine infused with dried rosemary. Pour the leaves with wine, leave for about a month in a dark place, strain and take before eating.

Cranberries, mashed with sugar: a teaspoon 4 times a day.

To adjust your diet for cardiomyopathy, follow these tips:

  • discard salt;
  • eat often, about 6 times a day, but in small portions;
  • quit smoking, drink less alcohol;
  • Choose foods that are lower in fat and cholesterol;
  • limit the amount of animal fat;
  • useful sour-milk, dairy products, fresh vegetables and fruits;
  • eat less flour and sweet;
  • if you are overweight – follow a diet for weight loss and reduce the load on the heart.

Hypertrophy of the left ventricle of the heart on an ECG (electrocardiogram) can be of several types.

All of them differ in such criteria or in the amplitude of indicators:

  1. The QRS vector can be deflected to the right or left.
  2. In the presence of pathology in the patient, a change in the position of the RvI wave is noticeable.
  3. With LVH in a person, in addition to changing the size of the heart, a deviation of the tooth height Rv and the shape of R, Rs will be clearly noticeable.
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In addition, left ventricular hypertrophy on the ECG is noticeable by a shift in the location of the myocardium, thickening of the walls of the ventricle and a change in the shape of the organ. An experienced cardiologist will be able to see all this after the study. Diagnosis of LVH should be prescribed by the attending physician after the initial examination of the patient and the collection of anamnesis.

The most accurately seen hypertrophy of the left ventricle of the heart on the ECG. As additional diagnostic methods, ultrasound of the heart, listening and CT can be used. These studies will help to immediately identify the presence of pathology. Based on the results, the doctor will choose the appropriate treatment.

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

Symptoms and Diagnosis

Suspicion of the presence of left ventricular hypertrophy may occur if the patient has the following conditions:

  • chest pain;
  • rapid breathing without physical exertion;
  • heart palpitations, rhythm disturbance;
  • dizziness, which may result in fainting conditions;
  • tremor, hyperhidrosis;
  • drops in blood pressure;
  • swelling of the face and limbs in the evening;
  • asthma attacks, causeless cough in a lying position;
  • fatigue.

In such cases, start with a cardiogram. If she showed obvious signs of LVH or HF, then the cardiologist can prescribe additional diagnostics to identify the true causes of this syndrome: electrocardiographic diagnosis with a large number of leads, ultrasound of the heart, Holter ECG monitoring, as well as a biochemical blood test.

If you suspect left ventricular hypertrophy, as a rule, a comprehensive examination is performed, and the syndrome is confirmed only if there are 10 signs characteristic of LVH.

If the patient carefully monitors his health, eats properly, performs moderate physical activity and adheres to the recommendations prescribed by the doctor, then the prognosis for LVH will be favorable. But if the patient does not make changes in his life and ignores the recommendations of the doctor, then the LVH detected can lead to the development of serious complications and pathologies.

Diagnosis of left ventricular hypertrophy occurs in several ways: this is the detection of signs of the disease on the ECG, examination of the heart by ultrasound or using a magnetic resonance imaging scanner. If you have any heart problems and symptoms of the disease, you should contact a cardiologist, and if you have already suffered a defect and suspect complications, you need a cardiac surgeon and, possibly, a treatment system.

ECG – a common diagnostic method, helps to know the thickness of the heart muscle and voltage signs. Nevertheless, it is difficult to detect LVH on an ECG without the participation of other methods: an erroneous diagnosis of hypertrophy can be made, since ECG symptoms that are characteristic of it can also be observed in a healthy person.

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LVH on ultrasound

An ultrasound study is more likely to judge the individual factors and causes of hypertrophy. The advantage of ultrasound is that this method allows not only to diagnose, but also to determine the features of the course of hypertrophy and the general condition of the heart muscle. Indicators of cardiac echocardiography reveal such changes in the left ventricle as:

  • ventricular wall thickness;
  • the ratio of myocardial mass to body weight;
  • coefficient of asymmetry of seals;
  • direction and speed of blood flow.

Heart MRI

Magnetic resonance imaging helps to clearly calculate the area and degree of enlargement of the ventricle, atrium or other compartment of the heart, to understand how strong the dystrophic changes are. Myocardial MRI shows all the anatomical features and the configuration of the heart as if “stratifying” it, which gives the doctor a complete visualization of the organ and detailed information about the condition of each department.

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Since the development of such a disease is accompanied by significant violations in the work and structure of the heart muscle, it is natural that electrocardiography is considered the main way to diagnose such a disease. When decoding the cardiogram of a patient with such a diagnosis, more than 10 deviations from the norm are detected, but some of them are implicit, and may indicate other pathologies.

In order for the diagnosis to be accurate and the electrocardiogram reliable, it is important to correctly conduct the diagnostic process itself and, of course, correctly decipher the ECG. When decoding an electrocardiogram, attention is drawn not only to the condition of the ventricle affected by hypertrophy, but also to the ratio of the right and left ventricles.

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.

Signs of left ventricular hypertrophy

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:

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. Depression of the ST segment and inversion of T in V5, V6, indicating LV overload.
  6. 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:

  1. A combination of LVH signs with a simultaneous deviation of the electrical axis of the heart to the right.
  2. A combination of signs of an increase in the pancreas and a deviation of the electrical axis of the heart to the left.
  3. The high R wave in V5, V6, as well as the high R wave over 7 mm in V1, V2.
  4. If there are signs of an increase in the pancreas, there is no S wave in V5-6.
  5. 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:

  1. 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.
  2. Unstable heart rate.
  3. Frequent changes in blood pressure (severe hypertension).
  4. Shortness of breath and difficulty in breathing.
  5. Severe angina pectoris and amplitude cardiomyopathy.
  6. Weakness and disability.
  7. Drowsiness.
  8. Soreness localized in the chest.
  9. Often occurring headaches as a direct consequence of the ailment.
  10. 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.

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In addition to signs of left ventricular hypertrophy, doctors distinguish two forms of cardiomyopathy that occur with LVH:

  1. Hypertrophic form.
  2. 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.

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

Symptoms of cardiomyopathy are not always obvious, often people are unaware of a problem. If the fetus did not develop correctly during pregnancy, there may be a congenital malformation and hypertrophy of the left heart. Such cases must be observed from birth and avoid complications. But if periodic interruptions occur in the work of the heart and a person feels any of these signs, it is possible that the walls of the ventricle are not in order. The symptomatology of this problem is as follows:

  • labored breathing;
  • weakness, fatigue;
  • pain in the chest;
  • low heart rate;
  • swelling of the face in the afternoon;
  • disturbed sleep: insomnia or excessive drowsiness;
  • headache.

Symptoms of the disease

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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Svetlana Borszavich

General practitioner, cardiologist, with active work in therapy, gastroenterology, cardiology, rheumatology, immunology with allergology.
Fluent in general clinical methods for the diagnosis and treatment of heart disease, as well as electrocardiography, echocardiography, monitoring of cholera on an ECG and daily monitoring of blood pressure.
The treatment complex developed by the author significantly helps with cerebrovascular injuries and metabolic disorders in the brain and vascular diseases: hypertension and complications caused by diabetes.
The author is a member of the European Society of Therapists, a regular participant in scientific conferences and congresses in the field of cardiology and general medicine. She has repeatedly participated in a research program at a private university in Japan in the field of reconstructive medicine.