Poor R Wave Progression
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;
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]
Differential Diagnosis
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
References
- ↑ Poor R-Wave Progression. By: Ross MacKenzie, MD. J Insur Med 2005;37:58–62