Increased QRS voltage in the limb leads

Increased QRS voltage accompanied by repolarization abnormalities in a life insurance applicant's electrocardiogram should alert the medical director to the possibility of left ventricular hypertrophy. If confirmed, left ventricular hypertrophy or increased left ventricular mass is a strong independent risk factor for future cardiac events and all cause mortality. The use of the electrocardiogram to diagnose left ventricular hypertrophy can be helpful, but there are limitations that need to be considered. This ECG case study illustrates some of the pitfalls in the electrocardiographic diagnosis of left ventricular hypertrophy.