Exam

R Wave

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R Wave, R Wave Progression, Poor R Progression, Preserved Precordial R Wave Progression, Tall R Wave in Lead V1

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