What causes abnormal are wave progression?
- Lead misplacement (especially in obese women)
- Old Anteroseptal or anterior wall myocardial infarction
- Left ventricular hypertrophy (LVH)
- Right ventricular hypertrophy (RVH)
- Left anterior fascicular block
- Left bundle branch block (LBBB)
- Infiltrative or dilated cardiomyopathy
What causes poor your wave progression?
- H: new Afib
- E: otherwise normal intervals
- A: left axis from inferior infarct
- R: poor R wave progression with anterior Q waves and transition shifting from V4 to V6, and loss of R waves in limb leads
- T: no hypertrophy
- S: no hyperacute T waves, mild lateral TWI
What is the significance of poor are wave progression?
The major causes associated with PRWP include:
- Prior anteroseptal MI
- Left Ventricular Hypertrophy (LVH)
- Right Ventricular Hypertrophy (RVH)
- Inaccurate lead placement (e.g. transposition of V1 and V3)
- Dilated cardiomyopathy
- May be a normal variant
What is normal are wave progression?
- Left bundle branch block
- Left anterior fascicular block
- Wolff-Parkinson-White syndrome, certain
- Right ventricular hypertrophy (especially that associated with chronic pulmonary disease)
- Left ventricular hypertrophy
- Anterior MIHmmmmmmm! Does this seem important now?
What does abnormal R wave progression mean?
Abstract. Poor R-wave progression is a common ECG finding that is often inconclusively interpreted as suggestive, but not diagnostic, of anterior myocardial infarction (AMI).
What is R wave transition?
0:114:04QRS Transitional Zone and R Wave Progression Explained, AnimationYouTubeStart of suggested clipEnd of suggested clipStarting with the interventricular septum in normal conduction depolarization of the septum isMoreStarting with the interventricular septum in normal conduction depolarization of the septum is initiated from the left bundle going to the right toward v1 and away from v6.
Can poor R wave progression be reversed?
PRWP indicates possible prior anterior myocardial infarction (MI); however, it is observed frequently in apparently normal individuals. In contrast, reversed R wave progression (RRWP), which occurs in as many as 2% of all hospitalized patients, may be more specific to cardiac disorders2).
How common is poor R wave progression?
Based on the commonly used criteria in practice (R-wave in V3 or V4 ≤2 mm), the prevalence of PRWP in the general population was 1.8% (372/20,739), and based on the Marquette system it was 0.5% (96/20,739).
What is good R wave progression?
Answer. The R wave should progress in size across leads V1 to V6. Normally, in lead V1, there is a small R wave with a deep S wave; the R-wave amplitude should increase in size with the transition zone, normally in leads V2 to V4.
What is abnormal ECG?
Abnormal results can signify several issues. These include: Defects or abnormalities in the heart's shape and size: An abnormal ECG can signal that one or more aspects of the heart's walls are larger than another meaning that the heart is working harder than normal to pump blood.
What happens if left ventricular hypertrophy is left untreated?
As a result of these changes, complications of left ventricular hypertrophy include: Reduced blood supply to the heart. Inability of the heart to pump enough blood to your body (heart failure) Abnormal heart rhythm (arrhythmia)
What is R wave sinus rhythm?
The QRS complex is made up of three waves. These waves indicate the changing direction of the electrical stimulus as it passes through the heart's conduction system. The largest wave in the QRS complex is the R wave.
What is sinus arrhythmia in ECG?
Sinus arrhythmia refers to a changing sinus node rate with the respiratory cycle, on inspiration and expiration. This is quite common in young, healthy individuals and has no clinical significance. The heart rate increases with inspiration, due to the Bainbridge reflex, and decreases with expiration.
Can right ventricular hypertrophy be reversed?
Currently, there is no treatment to reverse the thickening of these walls completely, although ACE inhibitors have been shown to help. Preventing right ventricular hypertrophy from getting worse is possible in many cases.
Does Gas affect ECG?
Visceral-cardiac reflex secondary to gastric distention which causes increased vagal tone can lead to ECG changes.
What is a anterior myocardial infarction?
An anterior wall myocardial infarction occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery suffers injury due to lack of blood supply.
Poor R-wave progression and the LATE mnemonic
Ventricular depolarization begins in the septum, where it proceeds from left to right. Then the ventricles depolarize simultaneously, but because of the greater mass of the left ventricle the sum of electrical vectors is directed leftwards.
Take home points for poor R-wave progression and the LATE mnemonic
The differential for poor R wave progression is LATE: LAFB/LABB, AMI (old or new), Tension (LVH), Emphysema/ECG lead misplacement
About the Author: Jesse McLaren
Dr. Jesse McLaren (@ECGcases), is an Emergency Physician in Toronto with a special interest in emergency cardiology quality improvement and education. He is an Assistant Professor at the University of Toronto.
