LVH (Romhilt-Estes) Criteria
Info
~Amplitude (any of the following)
Largest R or S wave in any limb lead >=20mm Yes No
S in V1 or V2 >=30mm Yes No
R in V5 or V6 >= 30mm Yes No
~ST depressions or T wave inversions in lateral precordial leads, I, and/or aVL ("LV Strain" where ST - T vector is opposite to the QRS vector)
With digitalis use Yes No
Without digitalis use Yes No
Left atrial enlargement Yes No
Left axis deviation (QRS -30 degrees or more negative) Yes No
QRS duration >= 0.09 sec Yes No
Intrinsicoid deflection in V5 or V6 >= 0.055 sec Yes No
R e s u l t s
~Amplitude (any of the following)
 
~ST depressions or T wave inversions in lateral precordial leads, I, and/or aVL ("LV Strain" where ST - T vector is opposite to the QRS vector)
 
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LVH (Romhilt-Estes) Criteria

The Romhilt-Estes Criteria performs well in regard to sensitivity (50-54%) and specificity (95-97%) in the detection of Left Ventricular Hypertrophy (LVH) on EKG. Other research (Pewsner, et al) find that in hypertensive patients, EKG criteria is quite inadequate to rule out LVH (is helpful in identifying it; but often patients with LVH do not meet criteria on EKG)

Other simple rules:

  • [Sokolow-Lyon Index] The sum of the S wave in V 1 and the R wave in either V 5 or V 6 being >35 mm (43% sensitive, 95% specific)
  • The sum of the largest precordial R wave and the largest precordial S wave >45 mm (45% sensitive, 93% specific)
  • R wave in aVL >=11 mm
  • R wave in V 5 or V 6 >27 mm
  • [Gubner Index] R wave in I + S wave in III >=25 mm

Romhilt-Estes Point System:

In this system the points are summed and interpreted as:

  • 0-3 points = LVH Unlikely
  • 4 points = Probable LVH
  • 5 points = Definite LVH
Criteria Points
Amplitude (any of the following)
  • Largest R or S wave in any limb lead >=20mm
3
  • S in V 1 or V 2 >=30mm
  • R in V 5 or V 6 >=30mm
ST depressions or T wave inversions in lateral precordial leads, I, and/or aVL ("LV Strain" where ST-T vector is opposite to the QRS vector)
  • With digitalis use
1
  • Without digitalis use
3
Left atrial enlargement 3
Left axis deviation (QRS -30 degrees or more negative) 2
QRS duration >=0.09 sec 1
Intrinsicoid deflection in V 5 or V 6 >=0.055 sec 1

Definitions:

  • Lateral precordial leads = V 4 , V 5 , V 6
  • Left atrial enlargement is present when
    • P wave duration in lead II >=0.120 sec OR
    • Negative component of the biphasic P wave in V 1 >=1 small box in area
  • Intrinsicoid deflection = Downslope of the R wave after its peak

Reference:

  1. Pewsner D, Juni P, Egger M, et al. Accuracy of electrocardiography in diagnosis of left ventricular hypertrophy in arterial hypertension: systematic review. BMJ . 2007;335:711.
  2. Romhilt DW, Bove KE, Norris RJ, et al. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation . 1969:40(2):185-95.