Which leads show LV strain pattern, which is associated with LVH?

• A. II, III, aVF
• B. I, aVL, V5-V6
• C. V1-V3
• D. V4R

Answer: (B)

LV strain is a repolarization abnormality that accompanies left ventricular hypertrophy, showing up as downsloping ST-segment depression with T-wave inversion in the lateral leads. The lateral view of the heart—leads I, aVL, and the lateral chest leads V5 and V6—best reveals this pattern. So, the combination of these lateral leads is the one that demonstrates LV strain associated with LVH.

The other lead groups point to different regions: inferior leads (II, III, aVF) reflect the inferior wall, anterior/septal leads (V1–V3) reflect the septum and anterior wall, and a right-sided lead (V4R) targets the right ventricle. These do not typically display the LV strain pattern.