LVH Voltage: Large R2

Report:

Sinus rhythm 86/min

Short PR interval 0.10”

Possible LGL syndrome

Left ventricular hypertrophy voltage

RL2 > 15mm = 26mm

Comment:

The precordial leads also have high voltages: SV1 + RV6 or RV6 (Sokolow-Lyon index) > 35 mm. A voltage criterion that does not apply is the Cornell voltage index: RaVL+SV3 > 28 mm (men) and RaVL+SV3 > 20 mm (women).

The trace is otherwise normal. In young subjects, say under 35 years, this can be a normal variant. However, even a more normal ECG than this one cannot be used to exclude true LVH: echocardiography is required38. The question whether this ECG’s voltages are the result of LVH cannot be answered.

Another trace, Fig 32a, with a vertical heart, has a huge 35 mm RL2. This time there is little doubt, as typical ST/T changes accompany the tall R waves in the inferior leads and the PTF is increased. The patient was a 74 year old woman following aortic valve replacement, with known and obvious LVH clinically. Her precordial leads suggest an infarction, but are in fact too high: she also had emphysema.