Left Ventricular Hypertrophy Case Studies

Home » MEDCLIN530 » EKG » 12-Lead EKG Confidence » VI. The Nonischemic Disorders: Hypertrophy » 17. Left Ventricular Hypertrophy » Left Ventricular Hypertrophy Case Studies
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Kevin Hodges
Vice Chair, Emergency Medicine
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Chris Anderson
Vice Chair, Pediatrics
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Table of Contents

Case 1: ST segment changes in LVH

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In LVH (Figure 17.15), the ST segment may point opposite the mean QRS axis (Figure 17.16). This is sometimes referred to as “strain pattern.” These ST segment changes can be seen in the frontal plane, the horizontal plane, or both. In either plane, the ST segment points away from the left ventricle, as it would in left bundle branch block or subendocardial ischemia of the lateral wall. ST elevation in leads V1, and V2 may be reciprocal changes due to the ST depression in the lateral leads, and not an indication of transmural ischemia or infarction.

Case 2: LVH simulating anterior wall infarction

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As the left ventricle mass increases, it creates larger negative voltages in leads V1 and V2. A point can be reached at which the negative voltage washes out the R waves in these leads, giving the appearance of septal infarction. The Q wave equivalents in V1 and V2 may be due solely to LVH. The ST segment changes in LVH, which point away from the lateral walls, can cause the appearance of ST elevation, simulating transmural ischemia of the inferior wall and septum.
On the other hand, HTN frequently is the underlying cause of LVH, and HTN is a major risk factor for coronary artery disease. LVH, by creating its own ST segment depression and elevation, as well as Q waves in the septal leads, complicates the interpretation of ischemia or infarction in these patients. Other tests and information are almost always necessary.

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