What does poor R wave mean?

As a medical professional with expertise in cardiology, I can explain the term "poor R wave progression" in the context of an electrocardiogram (ECG) reading. Definition: Poor R-wave progression (PRWP) is a term used to describe a specific pattern seen on an ECG. It refers to a gradual decrease in the amplitude of the R wave as you move from one lead to the next in the precordial leads (V1 to V6). Normally, as you move across the precordium, the R wave should increase in height, reflecting the spread of electrical activity across the heart's ventricles. When this expected increase does not occur, or the R wave diminishes instead, it is termed as poor R-wave progression. This finding is often inconclusively interpreted as it can be suggestive of an anterior myocardial infarction (AMI), but it is not diagnostic on its own. AMI, or a heart attack, occurs when there is a blockage in a coronary artery, leading to a part of the heart muscle being deprived of oxygen and nutrients. However, PRWP can also be seen in other conditions such as left ventricular hypertrophy (LVH), Wolff-Parkinson-White (WPW) syndrome, and even in healthy individuals, which is why it requires further evaluation. In clinical practice, doctors consider PRWP alongside other ECG changes, patient history, and physical examination findings to reach a more accurate diagnosis.

Definition. Poor R-wave progression (PRWP) is a common ECG finding that is often inconclusively interpreted as suggestive, but not diagnostic, of anterior myocardial infarction (AMI).