Left Ventricular Hypertrophy: A Common STEMI Mimic

Left ventricular hypertrophy (LVH) is a common condition where the left ventricle of the heart becomes enlarged. It is often mistaken for an acute myocardial infarction on the 12-lead electrocardiogram (ECG), leading to unnecessary activation of cardiac catheterization lab personnel and treatment of patients.

The most widely used criteria for diagnosing LVH is the Sokolow-Lyon criteria, which involves measuring the sum of the amplitude of the S wave in lead V1 and the R wave in lead V5/6. If this sum is greater than 35 mm, LVH is present. However, electrical remodeling of the left ventricle can cause ST elevation in leads V1-V3, as well as a 'strain' pattern on the ECG.

LVH is recognized as one of the most common STEMI mimics, with an incidence of around 25%. It may or may not exhibit ST changes and can be difficult to diagnose. In fact, LVH is often mistaken for an acute myocardial infarction, leading to unnecessary cardiac catheterization lab activations and treatments.

As advanced practice providers, it is essential to be able to discern dangerous rhythms on the ECG, including STEMI. However, there are many rhythms that mimic this feared arrhythmia, including LVH. By understanding the diagnostic criteria and electrocardiographic features of LVH, healthcare professionals can reduce the number of unnecessary cardiac catheterization lab activations and treatments.

In conclusion, left ventricular hypertrophy is a common condition that often mimics an acute myocardial infarction on the ECG. It is essential for healthcare providers to be aware of this condition and its diagnostic criteria in order to provide appropriate treatment and reduce unnecessary procedures.

Lvh with ivcd