R waves

Question 1

What are the key abnormalities of R waves

Answer 1

• Dominant R in V1
• dominant R in aVR
• poor R wave progression

Question 2

Is a dominant R wave in V1 normal in any population?

Answer 2

Yes, it can be normal in children

Question 3

What are the causes of a dominant R wave in V1?

Answer 3

RVH RBBB
Posterior MI HOCM
WPW Myotonic dystrophy

In Posterior MI–>dominant R with ST depression

Question 4

What are causes of a dominant R wave in aVR?

Answer 4

• Poisoning (e.g., TCAs)
  
  • Dextrocardia
  • Incorrect lead placement (e.g., reversed L+R arm)
  • HCM–?

Question 5

What are the causes of poor R wave progression?

Answer 5

• Prior anteroseptal MI
  
  • LVH
  • Incorrect lead placement
  • Obesity
  • Pericardial effusion