Dominant R-wave in V1

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Definition

  • There should be a small R-wave relative to the S-wave in V1

Differential Diagnosis

  • Normal in children and young adults
  • Right ventricular hypertrophy (RVH)
    • Pulmonary embolus
    • Persistence of infantile pattern
    • Left-to-Dright 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