Poor R Wave Progression

Definition

R wave height ≤ 3 mm in V3.

Causes

• Prior anteroseptal MI
• Left ventricular hypertrophy
• Inaccurate lead placement (e.g. transposition of V1 and V3)
• Dilated cardiomyopathy
• May be a normal variant

ECG Examples

Example 1

• Poor R wave progression secondary to prior anteroseptal MI

Example 2

• Poor R wave progression due to electrode misplacement (leads V1 and V3 reversed)

Further Reading

• ECG BASICS – Waves, Intervals, Segments and Clinical Interpretation
• ECG CLINICAL CASES – Your favourite ECG’s placed in clinical context with a challenging Q&A approach
• ECG and Cardiology Eponymous Syndromes – Cheats guide to eponymous emancipation
• ECG Reference Sites on the WEB – the best of the rest

Author Credits

References

• Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.