Poor R-wave Progression

Poor R wave progression is a non-specific finding that is suggestive of prior anterior myocardial infarction. It is a poorly defined term that implies diminished amplitude of the R wave in the precordium. It has been defined as an R wave less than 3 mm in lead V3 or decreasing R wave amplitude from V2 to V3 or V3 to V4. Poor R wave progression has been implicated in left ventricular hypertrophy, right ventricular hypertrophy and can be a normal variant.



1. Zema MJ, Kligfield P. ECG Poor R-Wave Progression: Review and Synthesis. Arch Intern Med. 1982;142(6):1145-1148. doi:10.1001/ARCHINTE.1982.00340190101018
2. Surawicz B, Knilans TK. Chou’s Electrocardiography in Clinical Practice. 6th ed. Elsevier; 2008.