What does it mean if I have poor R wave progression?

As a medical professional with expertise in cardiology, I can provide you with an explanation of what it means to have poor R wave progression. Poor R wave progression is a term used in electrocardiography (ECG) to describe a specific pattern observed in the ECG waveform. The R wave represents the depolarization of the ventricles during a heartbeat, and its progression refers to how the amplitude of the R wave changes across different leads on the ECG. In a normal ECG, the R wave typically increases in size as you move from leads that are closer to the heart's apex (the pointy end) to leads that are closer to the base (the broader end). This is because the electrical impulse that causes the ventricles to contract spreads from the endocardium (the inner lining of the heart) to the epicardium (the outer lining), and the leads are positioned to reflect this spread. When there is poor R wave progression, it means that the expected increase in the amplitude of the R wave is not seen as you move across the leads. This can be indicative of various cardiac conditions, including: 1. Myocardial infarction (heart attack): Damage to the heart muscle can disrupt the normal electrical conduction and lead to changes in R wave progression. 2. Bundle branch block: This is a condition where the electrical signals are delayed or blocked in one of the heart's main conduction pathways, which can alter the R wave progression. 3. Myocardial ischemia: Reduced blood flow to the heart muscle can also affect the ECG pattern. 4. Cardiomyopathy: This is a disease of the heart muscle that can lead to changes in the ECG, including poor R wave progression. 5. Anatomical variations: Sometimes, the pattern can be due to the natural variation in heart structure from person to person. It's important to note that poor R wave progression is not a diagnosis in itself but rather a finding that requires further evaluation by a healthcare professional to determine its cause and significance.

Poor R-wave progression is a common ECG finding that is often inconclusively interpreted as suggestive, but not diagnostic, of anterior myocardial infarction (AMI). ... An interpretive approach to the ECG with poor R-wave progression is presented that has clinical relevance in the daily treatment of patients.