Poor R Wave Progression
Overview
Poor R wave progression is classically suggestive of anterior MI, though may occur in certain other conditions.
Look For
- Gradual change in the direction of the QRS complex from negative to positive across the chest leads, generally with peak R wave height in V4 that tapers off over V5 and V6.
- Normal R wave progression:
![Normal R wave progression]()
- Poor R wave progression:
![Poor R wave progression]()
Causes of Poor R Wave Progression
- Normal variant
- Anterior myocardial infarction
- Left ventricular hypertrophy
- Right ventricular hypertrophy
- Incorrect chest lead placement
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------