Sokolow-Lyon Voltage

LVH increases the total muscle mass of the left ventricle. This generates a larger electrical vector directed posteriorly and to the left. On an ECG, this manifests as deeper negative deflections (S waves) in right-sided pre-cordial leads (V1/V2) and taller positive deflections (R waves) in left-sided leads (V5/V6, aVL, I).

True LVH often comes with "strain pattern": ST-segment depression and asymmetric T-wave inversion in the lateral leads (I, aVL, V5, V6). If voltage criteria are met AND a strain pattern is present, the specificity for actual anatomical hypertrophy approaches 100%.