Dr.S.Venkatesan MD

Low voltage LVH : Can be a common ECG finding

July 28, 2011 5:32 pm

LVH is classically diagnosed with high qrs voltage either in limb or chest leads or both.
High voltage is a specific ECG sign, presence of which would strongly suggest LVH , absence of which is not useful to rule out true LVH.
LVH with flattish or down sloping ST segment , with or without T inversion , can be a sole presentation of LVH . This should not be taken as sign of ischemia. Here is patient with such an ECG

Mechanism for LVH without high voltage

Intrinsic muscle electrophysiological property – Arrangement of muscle fibre orientation will determine the voltage .(Parallel vs perpendicular, disarray etc)
Pathological LVH with fibrotic process and interstitial hypertrophy may not record high voltage.
Presence of high voltage LVH would indicate a dominant physiological muscle mass that lacks interstitial reaction.
Finally , technical cause like thick chest wall in obese can dampen the LVH voltage.

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