Thanks to Dr. Nathan Blau for presenting on Cardiac Hypertrophy.

Pearls

Consider the patient’s clinical picture when reading EKG
- COPD, hypertension, athlete, history of volume overload, history of pressure overload, etc.
Right ventricular hypertrophy (RVH)
- Right axis deviation is the most common, and at times, the only EKG finding of RVH
- Large R-waves in the RIGHT sided leads (V1, V2), rSR’ pattern (but is not RBBB), deep S-wave in LEFT sided leads (V5, V6)

Left ventricular hypertrophy (LVH)
- Large R-waves in LEFT sided leads (V5, V6, I, and aVL) and deep S-waves in RIGHT sided leads (V1, V2)
- Athletes often have large QRS amplitudes due to ventricular remodeling, but do not have pathological hypertrophy
- Many of the voltage criteria for LVH are unreliable in the younger patients
Biventricular hypertrophy
- LVH + Right axis deviation
  - Right axis deviation does not occurs in LVH alone

Questions from the audience:

What voltage criteria do you use for LVH?
- The oldest and often most used criteria is the Sokolow-Lyon Criteria. No single criteria is perfect.

Practice with these sample EKGs provided by Dr. Blau: 2018.10.25 Cardiac Hypertrophy