- 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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