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ECG Poor R-Wave Progression: Review and Synthesis

ECG Poor R-Wave Progression: Review and Synthesis 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). Recent studies have shown that poor R-wave progression has the following four distinct major causes: AMI, left ventricular hypertrophy, right ventricular hypertrophy, and a variant of normal with diminished anterior forces. Standard ECG criteria that identify and distinguish these causes have been developed. An interpretive approach to the ECG with poor R-wave progression is presented that has clinical relevance in the daily treatment of patients. (Arch Intern Med 1982;142:1145-1148) References 1. Yamauchi K, Segal M, Tatematsu H, et al: Analysis of discrepancies between VCG and ECG interpretation of anterior wall myocardial infarction. J Electrocardiol 1977;10:171-178.Crossref 2. Young E, Cohn PF, Gorlin R, et al: Vectorcardiographic diagnosis and electrocardiographic correlation in left ventricular asynergy due to coronary artery disease-severe asynergy of the anterior and apical segments. Circulation 1975;51:467-476.Crossref 3. Zema MJ, Kligfield P: Electrocardiographic poor R wave progression: II. Correlation with angiography. J Electrocardiol 1979;12:11-15.Crossref 4. Starr JW, Wagner GS, Draffin RM, et al: Vectorcardiographic criteria for the diagnosis of anterior myocardial infarction. Circulation 1976;53:229-234.Crossref 5. Gunnar RM, Pietras RJ, Blackaller J, et al: Correlation of vectorcardiographic criteria for myocardial infarction with autopsy findings. Circulation 1967;35:158-172.Crossref 6. Levine HD, Young E, Williams RA: Electrocardiogram and vectorcardiogram in myocardial infarction. Circulation 1972;45:457-470.Crossref 7. McConahay DR, McCallister BD, Hallerman FS, et al: Quantitative analysis of the electrocardiogram and the vectorcardiogram: Correlations with the coronary arteriogram. Circulation 1970;42:245-259.Crossref 8. Hiyashi Y, Omae T, Hirota Y, et al: Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a ten-year period: IV. QS waves in the precordial leads. Am Heart J 1980;100:424-431.Crossref 9. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis , Criteria Committee of the New York Heart Association. Boston, Little Brown & Co, 1974, p 438. 10. Zema MJ, Kligfield P: Electrocardiographic poor R wave progression: I. Correlation with the Frank vectorcardiogram. J Electrocardiol 1979;12:3-10.Crossref 11. Zema MJ, Luminais S, Chiaramida S, et al: Electrocardiographic poor R wave progression: III. The normal variant. J Electrocardiol 1980;13:135-142.Crossref 12. Zema MJ, Collins M, Alonso D, et al: Electrocardiographic poor R wave progression: Correlation with autopsy findings. Chest 1980;79:195-199.Crossref 13. Savage RM, Wagner GS, Idekar RE, et al: Correlation of postmortem anatomic findings with electrocardiographic changes in patients with myocardial infarction. Circulation 1977;55:279-285.Crossref 14. Bodenheimer MM, Bonka VS, Helfant RH: Q waves and ventricular asynergy: Predictive value and hemodynamic significance of anatomic localization. Am J Cardiol 1975;35:615-618.Crossref 15. Myers GB, Klein HA, Stafes BE: Correlation of electrocardiographic and pathologic findings in anteroseptal infarction. Am Heart J 1948;36:535-575.Crossref 16. Carter WA, Estes EH Jr: Electrocardiographic manifestations of ventricular hypertrophy: A computer study of ECG-anatomic correlation in 319 cases. Am Heart J 1964;68:173-182.Crossref 17. Chou TC, Masangkay MP, Young R, et al: Criteria for the diagnosis of right ventricular hypertrophy. Circulation 1973;48:1262-1267.Crossref 18. Gove KE, Scott RC: The anatomy of chronic cor pulmonale secondary to intrinsic lung disease. Prog Cardiovasc Dis 1966;9:227-238.Crossref 19. Schepers GWH: The pathology of cor pulmonale. Trans Am Coll Cardiol 1957;7:48-92. 20. Benchimol A: Vectorcardiography . Baltimore, Williams & Wilkins Co, 1973, p 60. 21. Chou TC, Helm RA, Kaplan S: Clinical Vectorcardiography , ed 2. New York, Grune & Stratton Inc, 1974, p 106. 22. Taymor RC, Hoffman I, Henry E: The Frank vectorcardiogram in mitral stenosis. Circulation 1964;30:865-871.Crossref 23. Farnhan J, Shah PM: Left anterior hemiblock simulating myocardial infarction. Am Heart J 1976;92:363-367. 24. VanMieghem W: The diagnostic challenge of anterior infarction in the presence of left anterior hemiblock. Chest 1979;76:206-208. 25. Grant RP: The relationship of unipolar chest leads to the electrical field of the heart. Circulation 1950;1:878-892.Crossref 26. Kerwin AJ, McDean R, Tegelaar H: A method for the accurate placement of chest electrodes in the taking of serial electrocardiographic tracings. Can Med Assoc J 1960;82:258-261. 27. Hassett MA, Williams RR, Wagner GS: Transient QRS changes simulating acute myocardial infarction. Circulation 1980;62:975-979.Crossref 28. Gubner R, Ungerleider HE: Electrocardiographic criteria of left ventricular hypertrophy: Factors determining the evolution of the electrocardiographic patterns in hypertrophy and bundle branch block. Arch Intern Med 1943;72:196-209.Crossref 29. Lewis T: Observations upon ventricular hypertrophy with especial reference to preponderance of one or other chamber. Heart 1914;5:367-402. 30. Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1940;37:161-186.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

ECG Poor R-Wave Progression: Review and Synthesis

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1982.00340190101018
Publisher site
See Article on Publisher Site

Abstract

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). Recent studies have shown that poor R-wave progression has the following four distinct major causes: AMI, left ventricular hypertrophy, right ventricular hypertrophy, and a variant of normal with diminished anterior forces. Standard ECG criteria that identify and distinguish these causes have been developed. An interpretive approach to the ECG with poor R-wave progression is presented that has clinical relevance in the daily treatment of patients. (Arch Intern Med 1982;142:1145-1148) References 1. Yamauchi K, Segal M, Tatematsu H, et al: Analysis of discrepancies between VCG and ECG interpretation of anterior wall myocardial infarction. J Electrocardiol 1977;10:171-178.Crossref 2. Young E, Cohn PF, Gorlin R, et al: Vectorcardiographic diagnosis and electrocardiographic correlation in left ventricular asynergy due to coronary artery disease-severe asynergy of the anterior and apical segments. Circulation 1975;51:467-476.Crossref 3. Zema MJ, Kligfield P: Electrocardiographic poor R wave progression: II. Correlation with angiography. J Electrocardiol 1979;12:11-15.Crossref 4. Starr JW, Wagner GS, Draffin RM, et al: Vectorcardiographic criteria for the diagnosis of anterior myocardial infarction. Circulation 1976;53:229-234.Crossref 5. Gunnar RM, Pietras RJ, Blackaller J, et al: Correlation of vectorcardiographic criteria for myocardial infarction with autopsy findings. Circulation 1967;35:158-172.Crossref 6. Levine HD, Young E, Williams RA: Electrocardiogram and vectorcardiogram in myocardial infarction. Circulation 1972;45:457-470.Crossref 7. McConahay DR, McCallister BD, Hallerman FS, et al: Quantitative analysis of the electrocardiogram and the vectorcardiogram: Correlations with the coronary arteriogram. Circulation 1970;42:245-259.Crossref 8. Hiyashi Y, Omae T, Hirota Y, et al: Clinicopathological study of the heart and coronary arteries of autopsied cases from the community of Hisayama during a ten-year period: IV. QS waves in the precordial leads. Am Heart J 1980;100:424-431.Crossref 9. Diseases of the Heart and Blood Vessels: Nomenclature and Criteria for Diagnosis , Criteria Committee of the New York Heart Association. Boston, Little Brown & Co, 1974, p 438. 10. Zema MJ, Kligfield P: Electrocardiographic poor R wave progression: I. Correlation with the Frank vectorcardiogram. J Electrocardiol 1979;12:3-10.Crossref 11. Zema MJ, Luminais S, Chiaramida S, et al: Electrocardiographic poor R wave progression: III. The normal variant. J Electrocardiol 1980;13:135-142.Crossref 12. Zema MJ, Collins M, Alonso D, et al: Electrocardiographic poor R wave progression: Correlation with autopsy findings. Chest 1980;79:195-199.Crossref 13. Savage RM, Wagner GS, Idekar RE, et al: Correlation of postmortem anatomic findings with electrocardiographic changes in patients with myocardial infarction. Circulation 1977;55:279-285.Crossref 14. Bodenheimer MM, Bonka VS, Helfant RH: Q waves and ventricular asynergy: Predictive value and hemodynamic significance of anatomic localization. Am J Cardiol 1975;35:615-618.Crossref 15. Myers GB, Klein HA, Stafes BE: Correlation of electrocardiographic and pathologic findings in anteroseptal infarction. Am Heart J 1948;36:535-575.Crossref 16. Carter WA, Estes EH Jr: Electrocardiographic manifestations of ventricular hypertrophy: A computer study of ECG-anatomic correlation in 319 cases. Am Heart J 1964;68:173-182.Crossref 17. Chou TC, Masangkay MP, Young R, et al: Criteria for the diagnosis of right ventricular hypertrophy. Circulation 1973;48:1262-1267.Crossref 18. Gove KE, Scott RC: The anatomy of chronic cor pulmonale secondary to intrinsic lung disease. Prog Cardiovasc Dis 1966;9:227-238.Crossref 19. Schepers GWH: The pathology of cor pulmonale. Trans Am Coll Cardiol 1957;7:48-92. 20. Benchimol A: Vectorcardiography . Baltimore, Williams & Wilkins Co, 1973, p 60. 21. Chou TC, Helm RA, Kaplan S: Clinical Vectorcardiography , ed 2. New York, Grune & Stratton Inc, 1974, p 106. 22. Taymor RC, Hoffman I, Henry E: The Frank vectorcardiogram in mitral stenosis. Circulation 1964;30:865-871.Crossref 23. Farnhan J, Shah PM: Left anterior hemiblock simulating myocardial infarction. Am Heart J 1976;92:363-367. 24. VanMieghem W: The diagnostic challenge of anterior infarction in the presence of left anterior hemiblock. Chest 1979;76:206-208. 25. Grant RP: The relationship of unipolar chest leads to the electrical field of the heart. Circulation 1950;1:878-892.Crossref 26. Kerwin AJ, McDean R, Tegelaar H: A method for the accurate placement of chest electrodes in the taking of serial electrocardiographic tracings. Can Med Assoc J 1960;82:258-261. 27. Hassett MA, Williams RR, Wagner GS: Transient QRS changes simulating acute myocardial infarction. Circulation 1980;62:975-979.Crossref 28. Gubner R, Ungerleider HE: Electrocardiographic criteria of left ventricular hypertrophy: Factors determining the evolution of the electrocardiographic patterns in hypertrophy and bundle branch block. Arch Intern Med 1943;72:196-209.Crossref 29. Lewis T: Observations upon ventricular hypertrophy with especial reference to preponderance of one or other chamber. Heart 1914;5:367-402. 30. Sokolow M, Lyon TP: The ventricular complex in left ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1940;37:161-186.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Jun 1, 1982

References