Fig. 24.2 (a) Left ventricular hypertrophy (LVH), not associated with repolarization changes. Sinus rhythm, normal P wave, PR interval, QRS axis (+80°). Lead II = 20 mm, S in V2 + R in V5 = 47 mm (normal ≤ 45 mm). No ST/T changes. ECG from a man with severe hypertension. (b) Left ventricular hypertrophy with repolarization changes. Lead V5 from a patient with hypertensive heart disease. This complex shows a slightly broad P wave, normal PR interval. Prominent Q wave, due to septal depolarization, great increase in R wave size (40 mm), and ‘reverse-tick’ T wave inversion. These three findings are pathognomonic for LVH.
![fig24.2.gif](/wp-content/uploads/2016/08/fig24.2.jpg)
Fig. 24.3 (a) Left ventricular hypertrophy (LVH), repolarization criteria, no voltage criteria. Sinus rhythm, normal P wave, PR interval. QRS complex normal size throughout. Lateral lead ‘reverse-tick’ T wave inversion (lead I, II, aVL, ±V4, V5/6). This ECG could have come from a patient with an acute coronary syndrome, but coronary angiography was normal. Cardiac magnetic resonance imaging (MRI) (b,c) shows gross increase in left ventricular mass to twice normal size.
![fig24.3.gif](/wp-content/uploads/2016/08/fig24.3.jpg)
Hypertension, though difficult to define, diagnose and treat, underlies many strokes, myocardial infarcts and much heart failure. The ECG is useful in measuring:
- The severity of hypertension induced vascular damage (ECG left ventricular hypertrophy [LVH]).
- The response to treatment, by measuring the decrease in ECG LVH, and normalization of repolarization abnormalities.
- Arrhythmic complications.
Hypertension-induced vascular damage assessment
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