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Left Ventricular Hypertrophy Module

Left Ventricular Hypertrophy

Tech Series
ECG Interpretation

Thomas E. O'Brien
AS CCT CRAT RMA

Objectives

Upon completion of the accompanying narrative and practice, the student will be able to:

  • Recall the process for measurement to determine the presence of left ventricular hypertrophy
  • Apply the process for measurement to determine the presence of left ventricular hypertrophy
  • Determine whether there is electrocardiographic evidence of left ventricular hypertrophy

Analysis of ECGs

People may choose to analyze ECG’s in a number of different ways. The sequence doesn’t necessarily matter as long as you gather and report the proper information each time.

If your protocols are different, always follow them.



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Lessons

Lesson #1: Left Ventricular Hypertrophy (LVH)


Intro

Hypertrophy refers to an abnormal thickening of a chamber wall.

Simply put, this abnormal thickening translates to an increase in the voltage of the QRS complex.

The wall thickens due to increased vascular resistance over time

heart with left ventricular hypertrophy

Intro 2

QRS complexes will show greater amplitude (more muscle mass = more electrical activity)

Taller and deeper ventricular depolarization waves will be seen

Remember: Hypertrophy increases voltage – BBB increases duration.



Lesson #2: Determining LVH 1


Step 1

Determining the presence of LVH is a fairly simple and straight forward three-step process.

  • Refer to leads V1 & V2
  • Measure and select the deepest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Write this number down


Lesson #3: Determining LVH 2


Step 2

  • Refer to leads V5 & V6
  • Measure and select the tallest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line up to the tip of the tallest “R” wave.
  • Count the number of millimeters (small boxes)
  • Write this number down


Lesson #4: Determining LVH 3


Step 3

  • Add the 2 numbers together
  • If it adds up to 35mm or more, clinically you must suspect left ventricular hypertrophy


Lesson #5: LVH Analysis


Example

  • Note the red arrows. The deepest “QS” wave from V1 and V2 has been selected
  • The tallest R wave in V5 and V6 has been selected
  • What is the total number?
  • 37 mm, YES!
lvh ecg image 1


Lesson #6: Quick Check 1 321


Tracing

lvh ecg image q1

Take measurements for LVH on this tracing, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.


Measurement

What number did you get?

Show Answer 38mm




Lesson #7: Quick Check 2 321


Tracing

lvh ecg image q2

On this tracing, take LVH measurements, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.

Measurement

What number did you get?

Show Answer 58mm




Lesson #8: Quick Check 3 321


Tracing

lvh ecg image q3

Using the tracing, determine LVH measurements, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.


Measurement

What number did you get?

Show Answer 39mm




Lesson #9: Quick Check 4 321


Tracing

lvh ecg image q4

Take LVH measurements on this practice tracing, then answer the questions below.

Is LVH present?

Yes Incorrect.

No Correct!


Measurement

What number did you get?

Show Answer 32mm




Lesson #10: Quick Check 5 321


Tracing

lvh ecg image q5

Practice taking LVH measurements on this tracing, the answer the questions below.

Is LVH present?

Yes Incorrect.

No Correct!


Measurement

What number did you get?

Show Answer 24mm


Authors and Reviewers


Sources



Please sign in. This module is premium content.

Lessons

Lesson #1: Left Ventricular Hypertrophy (LVH)


Intro

Hypertrophy refers to an abnormal thickening of a chamber wall.

Simply put, this abnormal thickening translates to an increase in the voltage of the QRS complex.

The wall thickens due to increased vascular resistance over time

heart with left ventricular hypertrophy

Intro 2

QRS complexes will show greater amplitude (more muscle mass = more electrical activity)

Taller and deeper ventricular depolarization waves will be seen

Remember: Hypertrophy increases voltage – BBB increases duration.



Lesson #2: Determining LVH 1


Step 1

Determining the presence of LVH is a fairly simple and straight forward three-step process.

  • Refer to leads V1 & V2
  • Measure and select the deepest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Measure from the isoelectric line down to the tip of the deepest QS complex.
  • Write this number down


Lesson #3: Determining LVH 2


Step 2

  • Refer to leads V5 & V6
  • Measure and select the tallest ventricular depolarization of the 2 views (not including aberrant complexes)
  • Measure from the isoelectric line up to the tip of the tallest “R” wave.
  • Count the number of millimeters (small boxes)
  • Write this number down


Lesson #4: Determining LVH 3


Step 3

  • Add the 2 numbers together
  • If it adds up to 35mm or more, clinically you must suspect left ventricular hypertrophy


Lesson #5: LVH Analysis


Example

  • Note the red arrows. The deepest “QS” wave from V1 and V2 has been selected
  • The tallest R wave in V5 and V6 has been selected
  • What is the total number?
  • 37 mm, YES!
lvh ecg image 1


Lesson #6: Quick Check 1 321


Tracing

lvh ecg image q1

Take measurements for LVH on this tracing, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.


Measurement

What number did you get?

Show Answer 38mm




Lesson #7: Quick Check 2 321


Tracing

lvh ecg image q2

On this tracing, take LVH measurements, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.

Measurement

What number did you get?

Show Answer 58mm




Lesson #8: Quick Check 3 321


Tracing

lvh ecg image q3

Using the tracing, determine LVH measurements, then answer the questions below.

Is LVH present?

Yes Correct!

No Incorrect.


Measurement

What number did you get?

Show Answer 39mm




Lesson #9: Quick Check 4 321


Tracing

lvh ecg image q4

Take LVH measurements on this practice tracing, then answer the questions below.

Is LVH present?

Yes Incorrect.

No Correct!


Measurement

What number did you get?

Show Answer 32mm




Lesson #10: Quick Check 5 321


Tracing

lvh ecg image q5

Practice taking LVH measurements on this tracing, the answer the questions below.

Is LVH present?

Yes Incorrect.

No Correct!


Measurement

What number did you get?

Show Answer 24mm



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Reference Guide
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