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Electrocardiographic diagnosis of left ventricular hypertrophy

Ary L Goldberger, MD
Section Editor
David M Mirvis, MD
Deputy Editor
Brian C Downey, MD, FACC


Left ventricular hypertrophy (LVH) refers to an increase in the size of myocardial fibers in the main cardiac pumping chamber. Such hypertrophy is usually the response to a chronic volume or pressure load.

The two most important pressure overload states are systemic hypertension and aortic stenosis

The major conditions associated with left ventricular volume overload are aortic or mitral valve regurgitation and dilated cardiomyopathy.

Ventricular septal defects cause both right and left ventricular volume overload, while hypertrophic cardiomyopathy is an example of an inherited condition in which LVH (usually with asymmetric septal hypertrophy) occurs in the absence of any apparent hemodynamic pressure or volume overload. A physiologic type of hypertrophy with increase in wall thickness and left ventricular end-diastolic volume may occur in trained athletes. The "athletic heart" is often associated with electrocardiogram (ECG) voltage criteria for LVH.

LVH is not an acute condition. It takes weeks and usually months to years to develop. Patients with LVH from any cause are at increased risk for major cardiovascular complications, including congestive heart failure and cardiac arrhythmias [1,2]. ECG markers of LVH also were associated with a significant increase in all-cause mortality in a large prospective study (ARIC) of the general, middle-aged population [3]. These pathophysiologic outcomes may be fostered by the development of myocardial inflammation and fibrosis with LVH, as well as by the association of LVH due to systemic hypertension with renal and cerebrovascular disease. (See "Clinical implications and treatment of left ventricular hypertrophy in hypertension".)

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Literature review current through: Nov 2017. | This topic last updated: Aug 23, 2016.
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