II. Causes: Tall R Wave in Lead V1
- WPW Syndrome
- Right Bundle Branch Block
- Incomplete Right Bundle Branch Block (narrow QRS)
- Right Ventricular Hypertrophy
- Hypertrophic Cardiomyopathy
- Acute right ventricular dilatation in right ventricular strain pattern (e.g. massive Pulmonary Embolism)
- Posterior Myocardial Infarction
- Progressive Muscular Dystrophy
- Dextrocardia
- Misplaced precordial leads
- Normal variant in young healthy adult
- References
- Mattu (2018) Crit Dec Emerg Med 32(6):14
III. Evaluation: R Wave Progression
- Normal (Preserved Precordial R Wave Progression)
- R Waves gradually increase in size from minimal to absent in lead V1 to full length of QRS in lead V6
- R Wave should be at least >2 to 4 mm in lead V3 or V4 (or R Wave in V3 > 3 mm)
- R Wave in lead V4 > V3 (or R Wave in lead V3 > V2)
- R Wave should be longer than the S wave in lead V4
- Poor R Wave Progression
- R Wave <3 mm in lead V3
IV. References
- Berbarian, Brady and Mattu (2023) Crit Dec Emerg Med 37(2): 12-3