Left ventricular hypertrophy 1179395 220988059 2008-06-22T15:11:07Z DOI bot 6652755 Citation maintenance. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{DiseaseDisorder infobox | Name = Left ventricular hypertrophy | ICD10 = {{ICD10|I|51|7|i|30}} | ICD9 = {{ICD9|429.3}} | ICDO = | Image = | Caption = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | DiseasesDB = 7659 | MeshID = D017379 | }} '''Left ventricular hypertrophy''' ('''LVH''') is the thickening of the [[myocardium]] (muscle) of the [[left ventricle]] of the [[heart]]. ==Causes== While [[ventricular hypertrophy]] occurs naturally as a reaction to [[aerobic exercise]] and [[strength training]], it is most frequently referred to as a pathological reaction to [[cardiovascular disease]], or [[high blood pressure]].<ref name="titleAsk the doctor: Left Ventricular Hypertrophy">{{cite web |url=http://www.clevelandclinic.org/heartcenter/pub/guide/askdoctor/lvh.htm |title=Ask the doctor: Left Ventricular Hypertrophy |accessdate=2007-12-07 |format= |work=}}</ref> While LVH itself is not a disease, it is usually a marker for disease involving the heart.<ref name="pmid18030317">{{cite journal |author=Meijs MF, Bots ML, Vonken EJ, ''et al'' |title=Rationale and design of the SMART Heart study: A prediction model for left ventricular hypertrophy in hypertension |journal=Neth Heart J |volume=15 |issue=9 |pages=295–8 |year=2007 |pmid=18030317 |doi=}}</ref> Disease processes that can cause LVH include any disease that increases the [[afterload]] that the heart has to contract against, and some primary diseases of the muscle of the heart. Causes of increased afterload that can cause LVH include [[aortic stenosis]], [[aortic insufficiency]], and [[hypertension]]. Primary disease of the muscle of the heart that cause LVH are known as [[hypertrophic cardiomyopathy|hypertrophic cardiomyopathies]], which can lead into heart failure. ==Diagnosis== The principal method to diagnose LVH is [[echocardiography]], during which the thickness of the muscle of the heart can be measured. The [[electrocardiogram]] (ECG) often shows signs of increased voltage from the heart in individuals with LVH, so this is often used as a screening test to determine who should undergo further testing with an echocardiogram. ===Echocardiography=== Two dimensional echocardiography can produce images of the left ventricle. The thickness of the left ventricle as visualized on echocardiography correlates with its actual mass. Normal thickness of the left ventricular myocardium is from 0.6 to 1.1 cm (as measured at the very end of [[diastole]]. If the myocardium is more than 1.1 cm thick, the diagnosis of LVH can be made. ===ECG criteria for LVH=== There are multiple criteria used to diagnose LVH via electrocardiography. None of them are perfect. However, by using multiple different criteria the [[sensitivity (tests)|sensitivity]] and [[Specificity (tests) | specificity]] are increased. The Sokolow and Lyon criteria<ref>Sokolow M, Lyon TP. The ventriculAR complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J. 1949;37:161–186.</ref><ref name="titleTime-Voltage QRS Area of the 12-Lead Electrocardiogram : Detection of Left Ventricular Hypertrophy -- Okin et al. 31 (4): 937 -- Hypertension">{{cite web |url=http://hyper.ahajournals.org/cgi/content/full/31/4/937#R10 |title=Time-Voltage QRS Area of the 12-Lead Electrocardiogram : Detection of Left Ventricular Hypertrophy -- Okin et al. 31 (4): 937 -- Hypertension |accessdate=2007-12-07 |format= |work=}}</ref> *S in V1 + R in V5 or V6 (whichever is larger) =/> 35 mm *R in aVL =/> 11 mm The Cornell criteria<ref>{{cite journal |author=Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P |title=Improved sex-specific criteria of left ventricular hypertrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings |journal=Circulation |volume=75 |issue=3 |pages=565–72 |year=1987 |pmid=2949887 |doi=}}</ref> for the ECG diagnosis of LVH involves measurement of the sum of the R wave in lead aVL and the S wave in lead V<sub>3</sub>. The Cornell criteria for LVH are: *S in V<sub>3</sub> + R in aVL > 28 mm (men) *S in V<sub>3</sub> + R in aVL > 20 mm (women) Other voltage-based criteria for LVH include: *Lead I: R wave > 14 mm *Lead aVR: S wave > 15 mm *Lead aVL: R wave > 12 mm *Lead aVF: R wave > 21 mm *Lead V<sub>5</sub>: R wave > 26 mm *Lead V<sub>6</sub>: R wave > 20 mm ==Treatment== The enlargement is not permanent in all cases, and in some cases the growth can regress with the reduction of blood pressure.<ref name="pmid16627048">{{cite journal |author=Gradman AH, Alfayoumi F |title=From left ventricular hypertrophy to congestive heart failure: management of hypertensive heart disease |journal=Prog Cardiovasc Dis |volume=48 |issue=5 |pages=326–41 |year=2006 |pmid=16627048 |doi=10.1016/j.pcad.2006.02.001}}</ref> ==See also== * [[Cardiomegaly]] * [[Ventricular hypertrophy]] * [[Primary hyperparathyroidism]] ''' ==References== {{reflist}} ==Further reading== * {{cite book |author=Marriott, Henry J. L.; Wagner, Galen S. |title=Marriott's practical electrocardiography |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2001 |pages= |isbn=0683307460 |oclc= |doi=}} {{circulatory-stub}} {{Circulatory system pathology}} [[Category:Cardiology]] [[es:Hipertrofia ventricular izquierda]]