Left Ventricular Hypertrophy ECG Criteria

Through many studies, multiple criteria have been developed to diagnose LVH on an ECG; they are listed below:

Cornell criteria: Add the R wave in aVL and the S wave in V3. If the sum is greater than 28 millimeters in males or greater than 20 mm in females, LVH is present.

Modified Cornell Criteria: Examine the R wave in aVL. If the R wave is greater than 12 mm in amplitude, LVH is present.

Sokolow-Lyon Criteria: Add the S wave in V1 plus the R wave in V5 or V6. If the sum is greater than 35 mm, LVH is present.

Romhilt-Estes LVH Point Score System: If the score equals 4, LVH is present with 30% to 54% sensitivity. If the score is greater than 5, LVH is present with 83% to 97% specificity.

• Amplitude of largest R or S in limb leads ≥ 20 mm = 3 points
• Amplitude of S in V1 or V2 ≥ 30 mm = 3 point
• Amplitude of R in V5 or V6 ≥ 30 mm = 3 points
• ST and T wave changes opposite QRS without digoxin = 3 point
• ST and T wave changes opposite QRS with digoxin = 1 point
• Left Atrial Enlargement = 3 points
• Left Axis Deviation = 2 points
• QRS duration ≥ 90 ms = 1 point
• Intrinsicoid deflection in V5 or V6 > 50 ms = 1 point