The Electrocardiographic Findings in Left Ventricular Hypertrophy and Dilatation

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Abstract
The electrocardiographic findings were analyzed in 27 subjects with thickened left ventricular walls and in seven with left ventricular dilatation and a left ventricular wall of normal thickness as determined by biplane angiocardiography. Both groups satisfied equally the sets of criteria proposed by Wilson, by Sokolow, and by Noth for left ventricular hypertrophy as determined at necropsy. Those with a thickened left ventricular wall tended to have higher voltage in the unipolar leads and longer durations of the intrinsicoid deflection and of the QRS interval than those with left ventricular dilatation and a wall of normal thickness. High-grade left axis deviation and inversion of the T wave were confined to those with the thickest walls. Nevertheless, specific criteria in each set of criteria are often absent. There was also a large overlap between the accepted normal tracings and the findings in these groups of patients. It is suggested that an intrinsicoid deflection of 0.04 second or less in the first left precordial lead with a q separates most reliably the normal from those with left ventricular enlargement (a thickened left ventricular wall or left ventricular dilatation with or without a thickened left ventricular wall). The differential diagnosis of this latter group from myocardial infarction is discussed briefly.