Which ECG finding is most associated with left ventricular hypertrophy?

Which ECG finding is most associated with left ventricular hypertrophy?

• A. S in V1 + R in V5/V6 > 35 mm (men) or > 30 mm (women)
• B. ST-elevation in leads II, III, aVF
• C. Prolonged PR interval
• D. Tall T waves in leads V4-V6

Answer: (A)

Left ventricular hypertrophy tends to produce higher voltages in the chest leads because the thicker left ventricle generates more electrical current detectable on the ECG. The best-stablished litmus for LVH is the Sokolow-Lyon voltage criterion: add the S wave in the right precordial lead (V1) to the R wave in the left precordial leads (V5 or V6). If that sum exceeds 35 mm in men or 30 mm in women, LVH is suggested. This criterion specifically targets the increased myocardial mass that defines LVH, which is why it’s the most associated finding. Other options point to different problems. ST elevation in inferior leads (II, III, aVF) suggests an acute inferior myocardial infarction, not LVH. A prolonged PR interval indicates first-degree AV block. Tall T waves in the lateral precordial leads can occur with hyperkalemia or benign repolarization variants, and while repolarization changes can accompany LVH (strain pattern with ST depression and T-wave inversion in lateral leads), the hallmark clue for LVH remains the increased voltage described by the Sokolow-Lyon criterion.

Left ventricular hypertrophy tends to produce higher voltages in the chest leads because the thicker left ventricle generates more electrical current detectable on the ECG. The best-stablished litmus for LVH is the Sokolow-Lyon voltage criterion: add the S wave in the right precordial lead (V1) to the R wave in the left precordial leads (V5 or V6). If that sum exceeds 35 mm in men or 30 mm in women, LVH is suggested. This criterion specifically targets the increased myocardial mass that defines LVH, which is why it’s the most associated finding.

Other options point to different problems. ST elevation in inferior leads (II, III, aVF) suggests an acute inferior myocardial infarction, not LVH. A prolonged PR interval indicates first-degree AV block. Tall T waves in the lateral precordial leads can occur with hyperkalemia or benign repolarization variants, and while repolarization changes can accompany LVH (strain pattern with ST depression and T-wave inversion in lateral leads), the hallmark clue for LVH remains the increased voltage described by the Sokolow-Lyon criterion.