Heart Anatomy – ECG Changes

Left Ventricular Hypertrophy (LVH)

Sokolow-Lyon criterium
Romhilt-Estes Criteria for LVH
Cornell Voltage Criteria for LVH
Limb-lead voltage criteria

Left Atrial Enlargement (P-mitrale)

– Bifid P wave in lead II > 120 ms OR

– Biphasic P wave in V1 with negative portion > 40 ms

Right Atrial Enlargement (P-pulmonale)

– Peaked P wave in lead II > 2.5 mm in amplitude OR

– Peaked P wave in lead V1 > 1.5 mm

Right ventricular hypertrophy (RVH)

– Right axis deviation

– R > S in V1, R in V1 >=6 mm

– Dominant S wave in V5 or V6, S in V5 >=10 mm, S in V6 >=3 mm

– R in aVR >=4 mm

Biatrial Enlargement

– The P wave is biphasic with a large initial positive peak followed by a negative deflection

– The P wave is more than 0.04 seconds in duration

– The positive initial part of the P wave is > 1.5 mm and the negative terminal part of the P wave is > 1 mm

– Notched P waves with duration > 120 ms in limb leads, V5 or V6

– Bifid P wave in lead II with duration > 120 ms and increased amplitude of > 2.5 mm”

Left Ventricular Aneurysm

  • Persistent ST elevation seen > 2 weeks after an MI
  • Commonly seen in precordial leads
  • Associated with Q waves indicating infarct pattern
  • Inverted T waves can be seen