Poor R Wave Progression: Difference between revisions
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'''''Synonyms and keywords:''''' PRWP; poor R wave transition; delayed R wave transition; delayed transition; loss of R wave progression; | '''''Synonyms and keywords:''''' PRWP; poor R wave transition; delayed R wave transition; delayed transition; loss of R wave progression; loss of R waves | ||
==Overview== | ==Overview== | ||
Poor [[R wave]] progression across the precordium refers to an electrocardiographic finding where the normal increase in [[R wave]] amplitude as one progresses from V1 to V6 is lost. Although non-specific, this finding is consistent with a prior anterior [[myocardial infarction]]. | Poor [[R wave]] progression across the precordium refers to an electrocardiographic finding where the normal increase in [[R wave]] amplitude as one progresses from V1 to V6 is lost. Although non-specific, this finding is consistent with a prior anterior [[myocardial infarction]]. | ||
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The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 2–4 mm in leads V<sub>3</sub> or V<sub>4</sub> and/or there is presence of a reversed R wave progression, which is defined as R in V<sub>4</sub> < R in V<sub>3</sub> or R in V<sub>3</sub> < R in V<sub>2</sub> or R in V<sub>2</sub> < R in V<sub>1</sub>, or any combination of these.<ref>Poor R-Wave Progression. By: Ross MacKenzie, MD. J Insur Med 2005;37:58–62</ref> | The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 2–4 mm in leads V<sub>3</sub> or V<sub>4</sub> and/or there is presence of a reversed R wave progression, which is defined as R in V<sub>4</sub> < R in V<sub>3</sub> or R in V<sub>3</sub> < R in V<sub>2</sub> or R in V<sub>2</sub> < R in V<sub>1</sub>, or any combination of these.<ref>Poor R-Wave Progression. By: Ross MacKenzie, MD. J Insur Med 2005;37:58–62</ref> | ||
== | ==Causes== | ||
Poor R wave progression can be observed in the following settings: | Poor R wave progression can be observed in the following settings: | ||
* Faulty ECG recording technique | * Faulty ECG recording technique | ||
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* Right and left [[ventricular hypertrophy]] | * Right and left [[ventricular hypertrophy]] | ||
* [[Wolff–Parkinson–White syndrome]] | * [[Wolff–Parkinson–White syndrome]] | ||
==EKG Examples== | |||
The EKG below shows sinus bradycardia at 47/min and [[poor R wave progression]] in the anterior chest leads with Q waves in leads V2 to V4 which are diagnostic of anterior myocardial infarction. Note that unlike the normal septal Q waves that start later in the progression of the chest leads and at the same time grow larger, the Q waves in this patient are abnormal because they are present in leads V2, V3, and V4 and are larger than those in V5 and V6. The cardiogram also shows abnormal T wave inversion and slight ST elevation in leads V1 to V3. | |||
[[Image:Sinus bradycardia.jpg|center|500px]] | |||
==References== | ==References== | ||
Latest revision as of 23:48, 19 October 2012
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: PRWP; poor R wave transition; delayed R wave transition; delayed transition; loss of R wave progression; loss of R waves
Overview
Poor R wave progression across the precordium refers to an electrocardiographic finding where the normal increase in R wave amplitude as one progresses from V1 to V6 is lost. Although non-specific, this finding is consistent with a prior anterior myocardial infarction.
Definition
The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 2–4 mm in leads V3 or V4 and/or there is presence of a reversed R wave progression, which is defined as R in V4 < R in V3 or R in V3 < R in V2 or R in V2 < R in V1, or any combination of these.[1]
Causes
Poor R wave progression can be observed in the following settings:
- Faulty ECG recording technique
- Left bundle branch block
- Myocardial infarction
- Right and left ventricular hypertrophy
- Wolff–Parkinson–White syndrome
EKG Examples
The EKG below shows sinus bradycardia at 47/min and poor R wave progression in the anterior chest leads with Q waves in leads V2 to V4 which are diagnostic of anterior myocardial infarction. Note that unlike the normal septal Q waves that start later in the progression of the chest leads and at the same time grow larger, the Q waves in this patient are abnormal because they are present in leads V2, V3, and V4 and are larger than those in V5 and V6. The cardiogram also shows abnormal T wave inversion and slight ST elevation in leads V1 to V3.
References
- ↑ Poor R-Wave Progression. By: Ross MacKenzie, MD. J Insur Med 2005;37:58–62