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Electrophysiology/Characteristics/Morphology: Increased duration of QRS interval, delay of intrinsicoid deflection, and increased QRS voltage tend to occur. "Strain" refers to T-wave inversion with depressed upwardly convex ST segments in the setting of LVE. Leftward axis is common, but not always found with LVE. EKG diagnosis: See Romhilt-Estes Scoring System outlined in Table 1. Conditions impairing diagnosis: asymmetrical septal hypertrophy, prior MI, CHF, pericardial or pleural effusions, anasarca, pulmonary emphysema, RBBB, LBBB, obesity, concomitant right ventricular enlargement. False positive diagnosis can occur in children and young adults, or in patients who are emaciated or have a slender body build.
Significance:
Hypertension is the most common cause. New onset or increasing strain pattern may signify LV dilatation and failure, or myocardial ischemia, and warrants careful evaluation.
Treatment:
As per underlying cause.