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What does a poor R wave progression mean in a cardiogram?

Updated: 9/17/2019
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12y ago

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Poor R wave progression is a vague term used to describe the transition in voltage in the precordial leads of an electrocardiogram (ECG). It is not a diagnosis but simply describes a pattern frequently noted. In a "normal" individual there is a progressive increase in the magnitude of the voltage in the leads from V1 to V4. When the peak voltage occurs later than V4 it is considered diminished or delayed. The normal criteria are very old and were likely based upon pathologic data. Current ECG technology includes computer interpretation. This particular pattern is usually reported out as "cannot rule out anterior myocardial infarction." The placement of the precordial leads is paramount in obtaining a reliable ECG pattern. Frequently the precordial leads are placed in the wrong position in haste to obtain the electrocardiographic tracing. Women particulary large breasted are most likely to have the leads improperly placed as the left breast usually overlies the 4th and sometimes the 5th intercostal space (where the leads should be placed). In summary, the term poor R wave progression is a vague term and not a diagnosis. Verification of proper leads placement should be the first response followed by echocardiography if there remains concern that there has been prior myocardial injury.

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Q: What does a poor R wave progression mean in a cardiogram?
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Poor R wave progression is a vague term used to describe a variation in the pattern formed by the QRS complexes in the chest or precordisl leads. The QRS complex represents the upward and downward deflections denoting the electrical discharge with each heartbeat. Normally the R wave is taller than the S wave by the 4th lead (V4). If the transition does not occur until the 5th or 6th precordisl lead then this is commonly referred to as poor R wave progression. It is used as a distinction from clearly normal patterns and clearly abnormal patterns. It may be found in normal hearts and can frequently be caused by improper placement of the electrodes during the recording of the ECG tracing.


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