• Left ventricular hypertrophy

    Left ventricular hypertrophy

    • Left ventricular hypertrophy
      Heart left ventricular hypertrophy sa.jpg
      A heart with left ventricular hypertrophy in short-axis view
      Classification and external resources
      Specialty Cardiology
      ICD-10 I51.7
      ICD-9-CM 429.3
      DiseasesDB 7659
      MeSH D017379

      Left ventricular hypertrophy (LVH) is thickening of the heart muscle of the left ventricle of the heart, that is, left-sided ventricular hypertrophy.

      While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and strength training, it is most frequently referred to as a pathological reaction to cardiovascular disease, or high blood pressure. It is one aspect of ventricular remodeling.

      While LVH itself is not a disease, it is usually a marker for disease involving the heart. Disease processes that can cause LVH include any disease that increases the afterload that the heart has to contract against, and some primary diseases of the muscle of the heart.

      Causes of increased afterload that can cause LVH include aortic stenosis, aortic insufficiency and hypertension. Primary disease of the muscle of the heart that cause LVH are known as hypertrophic cardiomyopathies, which can lead into heart failure.

      Long-standing mitral insufficiency also leads to LVH as a compensatory mechanism.

      The principal method to diagnose LVH is echocardiography, with which the thickness of the muscle of the heart can be measured. The electrocardiogram (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing.

      Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as visualized on echocardiography correlates with its actual mass. Normal thickness of the left ventricular myocardium is from 0.6 to 1.1 cm (as measured at the very end of diastole. If the myocardium is more than 1.1 cm thick, the diagnosis of LVH can be made.

      • S in V1 or V2 + R in V5 or V6 (whichever is larger) ≥ 35 mm (≥ 7 large squares)
      • R in aVL ≥ 11 mm
      • S in V3 + R in aVL > 28 mm (men)
      • S in V3 + R in aVL > 20 mm (women)
      • ST-T vector opposite to QRS without digitalis
      • ST-T vector opposite to QRS with digitalis
      • Lead I: R wave > 14 mm
      • Lead aVR: S wave > 15 mm
      • Lead aVL: R wave > 12 mm
      • Lead aVF: R wave > 21 mm
      • Lead V5: R wave > 26 mm
      • Lead V6: R wave > 20 mm
      • OGN, osteoglycin
  • What Else?

    • Left ventricular hypertrophy