Question 1

Why are there multiple ECG criteria for LVH?

Accepted Answer

No single criterion offers both high sensitivity and high specificity. Each amplifies different aspects of the QRS complex (voltage, duration, repolarisation). Clinicians commonly apply 2–3 criteria together and consider LVH present if any one is positive.

Question 2

Can obesity affect the Cornell voltage?

Accepted Answer

Obesity can reduce precordial voltages, potentially masking LVH. The Cornell criteria are somewhat less affected by body habitus than the Sokolow-Lyon criteria because lead aVL is less influenced by chest-wall adipose tissue.

Question 3

Should I repeat the ECG before diagnosing LVH?

Accepted Answer

Isolated LVH on a single ECG in an asymptomatic patient should be confirmed with a repeat ECG and, if clinically indicated, echocardiography. Transient causes such as left bundle branch block, ventricular pacing, or electrolyte disturbances can produce voltage criteria.