The strain pattern occurs when the right ventricular wall is quite thick, and the pressure is high, as well. Strain causes ST segment depression and asymmetric T wave inversions in leads V1 to V3.
The most commonly used ECG criteria to diagnosed left ventricular hypertrophy (LVH) is below: Cornell criteria: Add the R wave in aVL and the S wave in V3 ... a typical T wave inversion pattern ...