LVH

Example 1

Left ventricular hypertrophy (LVH):

 Markedly increased LV voltages: huge precordial R and S waves that

overlap with the adjacent leads (SV2 + RV6 >> 35 mm).
 R-wave peak time > 50 ms in V5-6 with associated QRS broadening.
 LV strain pattern with ST depression and T-wave inversions in I, aVL and
V5-6.
 ST elevation in V1-3.
 Prominent U waves in V1-3.
 Left axis deviation.
Severe LVH such as this appears almost identical to  left bundle branch block  — the
main clue to the presence of LVH is the excessively high LV voltages. 
 Example 2

 There are massively increased QRS voltages — the S waves in V3 are so

deep they are literally falling off the page!
 The ST elevation in V1-3 is simply in proportion to the very deep S waves
(“appropriate discordance”).
 The LV strain pattern is seen in all leads with a positive R wave (V5-6, I, II,
III, aVF).

https://ecg-interpretation.blogspot.com/2013/08/ecg-interpretation-review-73-
lvh.html

https://www.healio.com/cardiology/learn-the-heart/case-questions/ecg-
cases/question-20-1