ECG Guru - Instructor Resources - R wave progression https://www.ecgguru.com/ecg/r-wave-progression en Normal 12-Lead Demonstrating Good R Wave Progression https://www.ecgguru.com/ecg/normal-12-lead-demonstrating-good-r-wave-progression <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/normal-12-lead-demonstrating-good-r-wave-progression"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/N%20105%20good%20R%20wave%20progr.jpg" width="1800" height="1063" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Do you need a good example of normal precordial R wave progression for your collection? &nbsp;It is important to teach your students what "normal" looks like, as a reference for the abnormal ECGs you will teach them later. &nbsp;</p><p>This 3-channel 12-lead ECG offers a normal frontal plane axis, as evidenced by Lead II having the tallest R wave of all the limb leads. &nbsp;It also demonstrates a normal "Z" axis. &nbsp;That is, the direction of depolarization on the horizontal plane is normal. &nbsp;This is seen in the progression of the QRS complexes from a negative V1 to a positive V6. &nbsp;Each of the chest leads should have an R wave. &nbsp;V1 normally has a small R wave, and a deeper S wave. &nbsp;The R wave reflects the depolarization of the septum, which flows TOWARD the V1 electrode. &nbsp;The S wave reflects the ventricles depolarizing, dominated by the left ventricle, which depolarizes AWAY from V1.</p><p>V6 will be all or nearly all positive, reflecting that the same heart is depolarizing TOWARD the V6 electrode, located in the 5th ICS in the mid-axillary line. &nbsp;When we evaluate the leads V2 through V5, we should see an orderly progression between the negative V1 and the positive V6. &nbsp;When viewed as an R-S ratio, we could say the R waves are becoming larger and the S waves smaller as we progress across the chest from right to left. &nbsp;Other factors, however, will affect the overall <strong>size</strong> of the QRS, such as the size and contents of the chest, and how close the electrode is to the heart. &nbsp;For that reason, the overall amplitude of V2 and V3 is usually larger, given their close proximity to the heart. &nbsp;V6 is smaller overall than V5 because it is farther from the heart, and more chest contents (lungs) are between the heart and the electrode. &nbsp;</p><p>Once your students understand what the ECG "should" look like, it is time to teach the abnormalities. &nbsp;Poor R wave progression (a not-very-helpful term) can be caused by a number of things, such as electrode misplacement, anterior M.I. with pathological Q waves, and chamber enlargement. &nbsp;For an excellent discussion of poor R wave progression, visit <a title="LITFL Poor R Wave Prog" href="http://lifeinthefastlane.com/ecg-library/poor-r-wave-progression/">Life In the Fast Lane.</a></p></div></div></div><div class="field field-name-field-rate-this-content field-type-fivestar field-label-above"><div class="field-label">Rate this content:&nbsp;</div><div class="field-items"><div class="field-item even"><form class="fivestar-widget" action="/taxonomy/term/441/feed" method="post" id="fivestar-custom-widget" accept-charset="UTF-8"><div><div class="clearfix fivestar-average-text fivestar-average-stars fivestar-form-item fivestar-hearts"><div class="form-item form-type-fivestar form-item-vote"> <div class="form-item form-type-select form-item-vote"> <select id="edit-vote--2" name="vote" class="form-select"><option value="-">Select rating</option><option value="20">Give Normal 12-Lead Demonstrating Good R Wave Progression 1/5</option><option value="40">Give Normal 12-Lead Demonstrating Good R Wave Progression 2/5</option><option value="60">Give Normal 12-Lead Demonstrating 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href="/ecg/r-wave-progression" typeof="skos:Concept" property="rdfs:label skos:prefLabel" datatype="">R wave progression</a></div></div></div><ul class="links inline"><li class="addtoany first last"><span><span class="a2a_kit a2a_target addtoany_list" id="da2a_1"> <a class="a2a_dd addtoany_share_save" href="https://www.addtoany.com/share#url=https%3A%2F%2Fwww.ecgguru.com%2Fecg%2Fnormal-12-lead-demonstrating-good-r-wave-progression&amp;title=Normal%2012-Lead%20Demonstrating%20Good%20R%20Wave%20Progression"><img src="/sites/all/modules/addtoany/images/share_save_256_24.png" width="256" height="24" alt="Share"/></a> </span> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(window.da2a)da2a.script_load(); //--><!]]> </script></span></li> </ul> Thu, 30 Jan 2014 05:05:46 +0000 Dawn 553 at https://www.ecgguru.com https://www.ecgguru.com/ecg/normal-12-lead-demonstrating-good-r-wave-progression#comments