A 52 year old woman comes to your OPD with complaints of dizziness on getting up.

 A 52 year old woman comes to your OPD with complaints of dizziness on getting up.

She has a past history of Myocardial infarction 7 years ago.

You decide to organize an ECG  which is given below :

1 . Comment on R wave from leads V1 - V 6.

There is poor progression of R wave from V1 - V6 .

Poor R wave progression refers to the absence of the normal increase in size of the R wave in the precordial leads when advancing from lead V1 to V6.

In lead V1, the R wave should be small. The R wave becomes larger throughout the precordial leads, to the point where the R wave is larger than the S wave in lead V4. The S wave then becomes quite small in lead V6.

2 . What are the causes of this phenomenon ?

The causes of Poor R Wave Progression are as follows:

Old anterior myocardial infarction

Lead misplacement (frequently in obese women)

Left bundle branch block or left anterior fascicular block

Left ventricular hypertrophy

Wolff-Parkinson-White syndrome

Dextrocardia

Tension pneumothorax with mediastinal shift

Congenital heart disease