Romhilt-Estes Criteria for Left Ventricular Hypertrophy


Biggest R or S wave in the limb leads greater than or equal to 20 mm; or S wave in V1 or V2 greater than or equal to 30 mm; or R wave in V5 or V6 greater than or equal to 30 mm (3 points)

Left atrial involvement - terminal deflection of P wave in V1 is 1 box wide, and 1 box deep or more (3 points)

Left axis deviation - QRS axis is -30 degrees or more negative (2 points)

QRS duration greater than or equal to 0.09 second (1 point)

Intrinsicoid deflection in V5 and V6 greater than or equal to 0.05 second (1 point)
ST-T segment changes ("LV strain" = ST-T vector shifted opposite to QRS vector)

Without digitalis (3 points)

With digitalis (1 point)

Total Criteria Point Count:


LVH Score

5 to 13 Points: LVH present
4 Points: LVH likely
0 to 3 Points: LVH unlikely


  1. Romhilt, DW, Bove KE, et al. A critical appraisal of the electrocardiographic criteria for the diagnosis of left ventricular hypertrophy. Circulation. 40:185, 1969. PubMed ID: 4240354 PubMed Logo


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