R Wave

↪ ECG Basics Homepage R wave Overview The R wave is the first upward deflection after the P wave. The R wave represents early ventricular depolarisation Abnormalities of the R wave There are three key R wave abnormalities: Dominant R wave in V1 Dominant R wave in aVR Poor R wave progression 1. Dominant R wave in V1 Causes of Dominant R wave in V1 Normal in children and young adults Right Ventricular Hypertrophy (RVH) Pulmonary Embolus Persistence of infantile pattern Left to right shunt Right Bundle Branch Block (RBBB) Posterior Myocardial Infarction (ST elevation in Leads V7, V8, V9) Wolff-Parkinson-White (WPW) Type A Incorrect lead placement (e.g. V1 and V3 reversed) Dextrocardia Hypertrophic cardiomyopathy Dystrophy Myotonic dystrophy Duchenne Muscular dystrophy Examples of Dominant R wave in V1 Normal paediatric ECG (2 yr old) ...