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Left ventricular hypertrophy is the thickening
of the myocardium of the left ventricle of the heart. Causes
While ventricular hypertrophy occurs naturally as a reaction to aerobic exercise and strength
training, it is most frequently referred to as a pathological reaction to cardiovascular
disease, or high blood pressure. While LVH itself is not a disease, it is usually
a marker for disease involving the heart. Disease processes that can cause LVH include
any disease that increases the afterload that the heart has to contract against, and some
primary diseases of the muscle of the heart. Causes of increased afterload that can cause
LVH include aortic stenosis, aortic insufficiency and hypertension. Primary disease of the muscle
of the heart that cause LVH are known as hypertrophic cardiomyopathies, which can lead into heart
failure. Long-standing mitral insufficiency also leads
to LVH as a compensatory mechanism. Diagnosis
The principal method to diagnose LVH is echocardiography, with which the thickness of the muscle of
the heart can be measured. The electrocardiogram often shows signs of increased voltage from
the heart in individuals with LVH, so this is often used as a screening test to determine
who should undergo further testing. Echocardiography
Two dimensional echocardiography can produce images of the left ventricle. The thickness
of the left ventricle as visualized on echocardiography correlates with its actual mass. Normal thickness
of the left ventricular myocardium is from 0.6 to 1.1 cm (as measured at the very end
of diastole. If the myocardium is more than 1.1 cm thick, the diagnosis of LVH can be
made. ECG criteria for LVH
There are several sets of criteria used to diagnose LVH via electrocardiography. None
of them is perfect, though by using multiple criteria sets, the sensitivity and specificity
are increased. The Sokolow-Lyon index:
S in V1 + R in V5 or V6 ≥ 35 mm R in aVL ≥ 11 mm
The Cornell voltage criteria for the ECG diagnosis of LVH involve measurement of the sum of the
R wave in lead aVL and the S wave in lead V3. The Cornell criteria for LVH are:
S in V3 + R in aVL>28 mm S in V3 + R in aVL>20 mm
The Romhilt-Estes point score system: Other voltage-based criteria for LVH include:
Lead I: R wave>14 mm Lead aVR: S wave>15 mm
Lead aVL: R wave>12 mm Lead aVF: R wave>21 mm
Lead V5: R wave>26 mm Lead V6: R wave>20 mm
Treatment The enlargement is not permanent in all cases,
and in some cases the growth can regress with the reduction of blood pressure and controlling
excitements/emotions strictly. LVH may be a factor in determining treatment
or diagnosis for other conditions. For example, LVH causes a patient to have an irregular
ECG. Patients with LVH may have to participate in more complicated and precise diagnostic
procedures, such as imaging, in situations in which a physician could otherwise give
advice based on an ECG. Associated genes
OGN, osteoglycin See also
Cardiomegaly Ventricular hypertrophy
Primary hyperparathyroidism References

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