The Cornell Voltage Criteria is one of the most accurate EKG methods for diagnosing Left Ventricular Hypertrophy (LVH). It accounts for gender-based differences in myocardial mass, using a sum of R in aVL and S in V3. Thresholds: Men > 28 mm, Women > 20 mm.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
ECG screening for left ventricular hypertrophy
Chronic hypertension monitoring
Sex-specific assessment (more sensitive in females)
Complements Sokolow-Lyon and other LVH criteria
Higher specificity than Sokolow-Lyon, particularly in women
Section 2
Formula & Logic
Formula
Cornell Product = (RaVL + SV3) × QRS duration
RaVL = amplitude of R wave in lead aVL (mm)
SV3 = amplitude of S wave in lead V3 (mm)
QRS duration in milliseconds
Simplified Cornell Voltage (without duration multiplier):
Men: RaVL + SV3 > 20 mm = LVH
Women: RaVL + SV3 > 28 mm = LVH
Section 3
Pearls/Pitfalls
Technical Notes
Measure in smallest boxes (0.5 mm divisions)
Large amplitudes may indicate athletic conditioning (normal)
Poor R wave progression can interfere with measurements
Cornell criteria more specific in women than Sokolow-Lyon
Should be interpreted in clinical context (HTN, symptoms)
