Poor R Wave Progression: Causes & Reasons

Possible Causes for Poor R Wave Progression

R wave progression in the precordial leads. [wikidoc.org]

If there is an R wave in V1 or V2, the term poor R wave progression, but not old anterior wall MI, can be used. [healio.com]

This is sometimes termed "poor R wave progression" or PRWP. [healio.com]

Infiltrative Cardiomyopathy

The electrocardiogram showed normal sinus rhythm, QS waves in the inferior leads, poor R progression in the precordial leads and T-wave inversion in I and aVL ( Figure 1 ) [revportcardiol.org]

Against it was the ECG showing poor R-wave progression and echocardiographic findings suggestive of an infiltrative disease, with symmetric biventricular wall thickening and [revportcardiol.org]

Cor Pulmonale

R wave progression RAE with and RVH multifocal atrial tachycardia return to top Differential Diagnosis return to top Treatments Consequences and Course return to top The [sharinginhealth.ca]

[…] hearted failure include: increased JVP hepatomegaly return to top Investigations lab investigations diagnostic imaging Lab Investigations Diagnostic Imaging ECG shows: RAD and poor [sharinginhealth.ca]

Chronic Obstructive Pulmonary Disease

ECG poor R wave progression requires an R wave in V3 <3 mm clockwise rotation of the heart secondary to hyperinflation results in a delayed precordial transition zone the [radiopaedia.org]

Pulmonary Edema

An electrocardiogram showed ST depression in leads V5–V6 and poor R wave progression in leads V1–V4. [jmedicalcasereports.biomedcentral.com]

Right Ventricular Dilatation

Figure 3 shows atrial fibrillation, poor R wave progression, and diffuse ST-segment abnormalities in an ECG from a patient with ischemic cardiomyopathy. [clevelandclinicmeded.com]

Bronchial Asthma

Asthma is a relatively common condition that is characterized by at least partially reversible inflammation of the airways and reversible airway obstruction due to airway hyperreactivity. It can be acute, subacute or chronic. Asthma is one of the most common chronic diseases in the world. According to the 2014 Global[…] [radiopaedia.org]

Pulmonary Embolism

A 29-year-old male patient was treated and followed up for a pulmonary embolism. The patient had no relevant medical history, other than the fact that he had smoked bonzai, a synthetic cannabinoid derivative, for 2 years. Hypercoagulability tests were normal. The use of synthetic cannabinoids is increasing in the[…] [ncbi.nlm.nih.gov]

Acute Massive Pulmonary Embolism

Abstract The aim of this study was to evaluate the contribution of clinical, angiographic and haemodynamic findings in predicting the cardiorespiratory efficacy of thrombolytic therapy in acute massive pulmonary embolism. Haemodynamic measurements and pulmonary angiography were performed before (H0) and 12 h[…] [ncbi.nlm.nih.gov]

Recurrent Pulmonary Embolism

Twenty-six patients have undergone inferior vena caval interruption with a Greenfield filter. One patient (3.8%) developed a fatal, recurrent pulmonary embolism. Postmortem examination documented the presence of thrombus within the filter, proximal extension of thrombus beyond the filter apex, and fresh pulmonary[…] [ncbi.nlm.nih.gov]

Acute Cor Pulmonale

Chest. 2015 Jan;147(1):259-265. doi: 10.1378/chest.14-0877. Author information 1 Section Thorax-Vascular Disease-Abdomen-Metabolism, Université de Versailles Saint-Quentin-en-Yvelines, Saint-Quentin en Yvelines, France. 2 Intensive Care Unit, Ambroise-Paré, Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance[…] [ncbi.nlm.nih.gov]

Pneumothorax

The underlying pathophysiology of pneumothorax is reviewed in this section. Spontaneous pneumothorax Spontaneous pneumothorax in most patients occurs from the rupture of blebs and bullae. Although PSP is defined as occurring in patients without underlying pulmonary disease, these patients have asymptomatic blebs[…] [emedicine.medscape.com]

Eisenmenger Syndrome

Last revised by Henry Knipe ◉ ◈ on 14 Jun 2022 Citation, DOI & article data Citation: Singh G, Knipe H, Worsley C, et al. Eisenmenger syndrome. Reference article, Radiopaedia.org (Accessed on 05 Dec 2022) https://doi.org/10.53347/rID-6301 The Eisenmenger syndrome is a complication of an uncorrected high-flow,[…] [radiopaedia.org]

Lateral Myocardial Infarction

EKG Examples Shown below is an EKG demonstrating sinus rhythm and a QRS with a rightward axis, as well as wide Q waves in leads I and aVL as well as a poor R wave progression [wikidoc.org]

LVH (may have QS pattern or poor R wave progression in leads V1-3) RVH (tall R waves in V1 or V2 may mimic true posterior MI) Complete or incomplete LBBB (QS waves or poor [ecg.utah.edu]

QS waves in the anteroseptal leads (V1-4) with poor R wave progression indicate prior anteroseptal infarction. [lifeinthefastlane.com]

Right Ventricular Outflow Obstruction

Abstract Resting left ventricular (LV) function was evaluated in 29 infants with isolated right ventricular (RV) outflow obstruction. Age-corrected cardiac index was significantly inversely correlated with the degree of obstruction (r = 0.59, p = 0.0001). Right ventricular hypertension resulted in septal displacement[…] [ncbi.nlm.nih.gov]

Congenital Pericardium Anomaly

Her electrocardiogram showed poor R wave progression. Postero-anterior chest -X ray showed cardiac levoposition with borderline cardiac size (Figure1). [ispub.com]

In other cases the ECG may show typical findings such as right axis deviation, incomplete or complete right bundle branch block and poor R‐wave progression due to clockwise [revportcardiol.org]

Electrocardiogram Electrocardiographic manifestations of pericardial absence are: bradycardia, right bundle branch block, poor R-wave progression secondary to leftward displacement [ispub.com]

Basilar Artery Thrombosis with Occlusion of a Precerebral Artery

[…] ambulatory abnormal', 'electrocardiogram change', 'electrocardiogram delta waves abnormal', 'electrocardiogram low voltage', 'electrocardiogram poor r-wave progression', [definedterm.com]

[…] peaked', 'electrocardiogram u wave inversion', 'electrocardiogram u-wave abnormality', 'electrocardiogram u-wave biphasic', 'electrocardiogram abnormal', 'electrocardiogram [definedterm.com]

[…] wave amplitude decreased', 'electrocardiogram t wave amplitude increased', 'electrocardiogram t wave biphasic', 'electrocardiogram t wave inversion', 'electrocardiogram t wave [definedterm.com]

Left Anterior Fascicular Block

Effects of LAFB on Diagnosing Infarctions and Left Ventricular Hypertrophy [ edit ] LAHB may be a cause of poor R wave progression across the precordium causing a pseudoinfarction [en.wikipedia.org]

Case Interpretation Left anterior fascicular block (LAFB) Leftward axis qR in I and aVL rS in III QRS may be normal or slightly prolonged Poor R-wave progression is common [ecgweekly.com]

Effects of LAFB on Diagnosing Infarctions and Left Ventricular Hypertrophy LAHB may be a cause of poor R wave progression across the precordium causing a pseudoinfarction [ipfs.io]

Diffuse Intraventricular Block

[…] with a U-wave (a “T-U fusion complex”) Poor R-wave progression (PRWP) Prior anteroseptal MI LVH Abnormally high placement of the mid-precordial electrodes Normal variant [lifeinthefastlane.com]

Figure 3 shows atrial fibrillation, poor R wave progression, and diffuse ST-segment abnormalities in an ECG from a patient with ischemic cardiomyopathy. [clevelandclinicmeded.com]

Hypothermia Congenital prolonged QT syndrome *Hypokalemia — the actual QT-interval is normal; the QT-interval appears prolonged because of the presence of fusion of the T-wave [lifeinthefastlane.com]

Cardiac Neurofibroma

Electrocardiography had shown atrial fibrillation, poor R wave progression in precordial leads, and T wave inversion in the inferior leads and precordial leads V4–6. [ncbi.nlm.nih.gov]

Arrhythmogenic Right Ventricular Dysplasia Type 5

Résumé La dysplasie arythmogène du ventricule droit (DAVD) est une cardiomyopathie associant un remplacement fibro-adipeux progressif et transmural plus ou moins diffus de la paroi du ventricule droit (VD) à l’origine d’arythmies ventriculaires et de morts subites (fig. 1). Au stade précoce de la maladie, les[…] [link.springer.com]

Biventricular Hypertrophy

R wave progression across the precordium causing a pseudoinfarction pattern mimicking an anteroseptal infarction. [wikidoc.org]

Sensitivity 22% and specificity of 100%. [1] Effects of Left Anterior Hemiblock on Diagnosing Acute myocardial infarction and Left Ventricular Hypertrophy LAHB may be a cause of poor [wikidoc.org]

Acute Atrial Infarction

In contrast, poor R wave progression is commonly observed with LVH and with acute or chronic right ventricular overload. [angelfire.com]

If there is an R wave in V1 or V2, the term poor R wave progression, but not old anterior wall MI, can be used. [healio.com]

Poor R wave progression, sometimes with actual QS waves, can be due solely to improper placement of chest electrodes above their usual position. [angelfire.com]

Sarcoglycanopathy

[…] each and poor R wave progression from V1 to V3 and R>S in V1 and V2 in two patients each. [neurologyindia.com]

The common ECG change was T wave inversion from V1 to V3, seen in four patients, left ventricular hypertrophy and RBBB (right bundle branch block) pattern in three patients [neurologyindia.com]

Left Bundle Branch Block

ST elevation and poor R-wave progression were improved during LBBB. [ncbi.nlm.nih.gov]

ECGs showing the LBBB Note the following ECG features of the LBBB: -Downwardly deflected QRS -Delayed R wave progression -Wide QRS -Poor or delayed R wave progression (no [ecgsforems.blogspot.com]

[…] always go in the opposite direction to the main vector of the QRS complex Poor R wave progression in the chest leads Left axis deviation ECG QRS Morphology QRS Morphology [lifeinthefastlane.com]

Cardiac Dilatation

Poor R-wave progression with QS complexes in V1-4 (“pseudo-infarction” pattern). Frequent ventricular ectopics and ventricular bigeminy (seen with severe DCM). [lifeinthefastlane.com]

Figure 3 shows atrial fibrillation, poor R wave progression, and diffuse ST-segment abnormalities in an ECG from a patient with ischemic cardiomyopathy. [clevelandclinicmeded.com]

Common ECG associations with DCM Left atrial enlargement -> may progress to atrial fibrillation. [lifeinthefastlane.com]

Left Posterior Fascicular Block

One last feature I want you to notice is the poor R-wave progression and late transition! This is a normal finding for left anterior fascicular block (LAFB). [ems12lead.com]

Right Ventricular Dilation — see poor R wave progression as dilated RV pushes LV posteriorly resulting in loss of anterior forces. [nps.freeservers.com]

[…] in leads I and/or aVL R-peak time in lead aVL > 0.04s, often with slurred R wave downstroke QRS duration usually < 0.12s unless coexisting RBBB Usually see poor R progression [ecg.utah.edu]

Takotsubo Cardiomyopathy

Electrocardiogram showed right axis deviation, poor R-wave progression, and diffuse ST-segment elevation in the anterior leads, and cardiomegaly was observed by roentgenogram [ncbi.nlm.nih.gov]

This demonstrates resolution of ST-segment elevation, and now with diffuse T-wave inversion and poor R-wave progression. [emedicine.medscape.com]

Abnormal Origin of the Pulmonary Artery

R wave progression (PRWP) 9 defined by an R wave height < 3 mm in lead V3 ALCAPA refers to a cardiovascular anomaly where the left main coronary artery arises from the pulmonary [radiopaedia.org]

[…] ventricular voltage (HLVV) 8 meeting voltage criteria of left ventricular hypertrophy characteristic of adolescents and older children may be accompanied by left axis deviation poor [radiopaedia.org]

Anasarca

Electrocardiogram showing reduced QRS complex voltages and poor R-wave progression across the septum, reminiscent of myocardial infarction. [ndt.oxfordjournals.org]

Electrocardiogram showing reduced QRS complex voltages and poor R-wave progression across the septum, reminiscent of myocardial infarction. Fig. 1. [ndt.oxfordjournals.org]

This patient's electrocardiogram showed the cardinal features of cardiac amyloidosis, with reduced QRS complex voltages over standard leads, as well as poor R-wave progression [ndt.oxfordjournals.org]