title: LVH and the diagnosis of STEMI - how should we apply the current guidelines?
abstract: Left ventricular hypertrophy (LVH) induces changes in the depolarization and repolarization of the heart that alter the resting electrocardiogram (ECG). These changes include widening of the QRS duration, an increase in the QRS amplitude and secondary changes in the ST segment and T waves. Typically, there is ST segment depression and T wave inversion (or biphasic T waves) in the lateral leads and ST segment elevation (STE) in the precordial leads V1-V3. However, other patterns of ST-T changes may occur. These changes may vary over time and may not necessarily reflect acute ischemia. The ST-T changes secondary to LVH interfere with ECG interpretation and may affect our accuracy in diagnosing STEMI and other forms of active ischemia. The current guidelines specify thresholds for STE in patients without LVH for whom acute reperfusion therapy is indicated; however, there are no such thresholds for patients with LVH.
authors.affiliation: The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, TX, USA. Electronic address: ybirnbau@bcm.edu.
authors.forename: Yochai
authors.initials: Y
authors.lastname: Birnbaum
authors.affiliation: The Section of Cardiology, Baylor College of Medicine, Houston, TX, USA; Texas Heart Institute, Baylor St. Luke's Medical Center, Houston, TX, USA.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Alam
mesh_terms: D004562:Electrocardiography / Q000379:methods*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis* / Q000503:physiopathology*; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology*; D017410:Practice Guidelines as Topic; D012307:Risk Factors