Mechanism:

• Hypertrophy of the left ventricular musculature as a consequence of systolic or diastolic overload
  
• This determines:
  
  
  
  • Rotation of the cardiac axis in the superior and posterior direction
    
  • Increase in voltage
    
  • Lengthening of impulse conduction
    
  • Relative ischemia of the inner layer with disturbed repolarization resulting in current flow from the outer to the inner layer

ECG characteristics:

• Left axis to marked left axis deviation
  
• Widened QRS complexes (QRS up to 0.11 s; turning point in V5/6 > 0.05 s)
  
• High voltage of the R/S amplitudes (see indices)
  
• Left ventricular repolarization changes (T wave inversion, ST depression)
  
• Other criteria with left bundle branch block!

Indices with left ventricular hypertrophy:

• Sokolow index (S V1 + RV5 > 3.5 mV)
  
  
  
  • Sensitivity 25-43%, specifity 95%
  
  
• Lewis-Index (RI + S III – RIII-S I > 1,7 mV)
  
• Cornell-Index (RaVL + S V3 > 35 mm)
  
• Romhilt-Estes point system with assessment of: