ECG changes in left ventricular hypertrophy (LVH)

Last reviewed 04/2022

If there is left ventricular hypertrophy then this will result in :

  • a tall R wave (greater than 25mm in V5 or V6), or R plus S greater than 35 mm (1)

  • a deep S in V1 or V2

  • if there is significant left ventricular 'strain' then there are also inverted T waves in V5 and V6 and possible ST depression

  • left axis deviation may also be present

  • QRS may be slightly prolonged


  • a systematic review investigating the accuracy of ECGs in the diagnosis of LVH has been undertaken (2)
    • from the study data
      • in primary care, a negative electrocardiogram result would reduce the typical pre-test probability from 33% to 31%. In secondary care the typical pre-test probability of 65% would be reduced to 63%
    • the authors concluded that electrocardiographic criteria should not be used to rule out left ventricular hypertrophy in patients with hypertension

Click here for an ECG and further information concerning left ventricular hypertrophy