Cardiac Hypertrophy Pearls

Thanks to Dr. Nathan Blau for presenting on Cardiac Hypertrophy.


  • Consider the patient’s clinical picture when reading EKG

    • COPD, hypertension, athlete, history of volume overload, history of pressure overload, etc.

  • Right ventricular hypertrophy (RVH)

    • Right axis deviation is the most common, and at times, the only EKG finding of RVH

    • Large R-waves in the RIGHT sided leads (V1, V2), rSR’ pattern (but is not RBBB), deep S-wave in LEFT sided leads (V5, V6)

  • Left ventricular hypertrophy (LVH)

    • Large R-waves in LEFT sided leads (V5, V6, I, and aVL) and deep S-waves in RIGHT sided leads (V1, V2)

    • Athletes often have large QRS amplitudes due to ventricular remodeling, but do not have pathological hypertrophy

    • Many of the voltage criteria for LVH are unreliable in the younger patients

  • Biventricular hypertrophy

    • LVH + Right axis deviation

      • Right axis deviation does not occurs in LVH alone

Questions from the audience:

  • What voltage criteria do you use for LVH?

    • The oldest and often most used criteria is the Sokolow-Lyon Criteria. No single criteria is perfect. 

Practice with these sample EKGs provided by Dr. Blau: 2018.10.25 Cardiac Hypertrophy

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