Hypertension images: electrocardiographic left ventricular hypertrophy.

The electrocardiogram is an inexpensive adjunct for assessing target organ damage in hypertensive patients. The gender-specific Cornell voltage criteria (men: R(aVL) + S(V3) >35 mm; women: R(aVL) + S(V3) >25 mm) have better overall accuracy than the often-used Sokolow-Lyon or Romhilt-Estes criteria. One of the earliest electrocardiographic findings of hypertensive heart disease is a duration of the negative phase of the P wave in chest lead V1 of >0.04 seconds, a manifestation of left atrial enlargement or abnormality. There is no other cardiovascular risk factor more potent than left ventricular hypertrophy with a "strain pattern." Despite limitations in determining hypertensive heart disease, the electrocardiogram provides other information that is useful in the management of patients with hypertension.