Poor R-wave progression

Definition

• R waves should become more prominent progressing through the precordial leads
• V1 should have a very small R wave
• V4 should have the R wave larger than the S wave
• V6 should have a very small S wave
• Poor R-wave progression is defined as R wave ≤ 3 mm in V3

Differential Diagnosis

• Old anterior myocardial infarction
• With triad of low-voltage limb leads and high-voltage precordial leads, suggests dilated cardiomyopathy
• Left ventricular hypertrophy (LVH)
• Normal variant
• Incorrect lead placement