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ECG - Causes of a Dominant R wave in V1
Related Subjects: |ECG Basics |ECG Axis |ECG Analysis |ECG LAD |ECG RAD |ECG Low voltage |ECG Pathological Q waves |ECG ST/T wave changes |ECG LBBB |ECG RBBB |ECG short PR |ECG Heart Block |ECG Asystole and P wave asystole |ECG QRS complex |ECG ST segment |ECG: QT interval |ECG: LVH |ECG RVH |ECG: Bundle branch blocks |ECG Dominant R wave in V1 |ECG Acute Coronary Syndrome |ECG Crib sheets
🔎 Causes of a Tall R Wave in V1
- 💪 Right Ventricular Hypertrophy (RVH): Increased RV muscle mass → tall R wave in V1. ⚠️ Seen in pulmonary hypertension (COPD, PE, congenital heart disease).
- ❤️ Posterior Myocardial Infarction: Loss of posterior LV forces produces a reciprocal tall R in V1. ⚠️ Often with ST depression & upright T in V1–V3 → mimics RVH.
- ⚡ Right Bundle Branch Block (RBBB): Delayed RV activation → prominent terminal R in V1. ⚠️ May be isolated or due to structural/ischaemic disease.
- 🔄 Wolff-Parkinson-White (WPW): Pre-excitation via left-sided accessory pathway (Type A) → tall R in V1. ⚠️ Associated with SVT; look for short PR + delta wave.
- 🧬 Hypertrophic Cardiomyopathy (HCM): Asymmetric septal hypertrophy can cause dominant R in V1. ⚠️ Risk of HF & sudden cardiac death; family history key.
- 🙂 Normal Variant: Some healthy young individuals have a tall R in V1. ⚠️ No further workup if asymptomatic and no other ECG abnormalities.
- ➡️ Dextrocardia: Heart on right side of chest → mirror image ECG. ⚠️ Confirm with CXR or echo; look for reversed limb lead polarity.
- 🧠 Neuromuscular Disorders: Duchenne & Myotonic dystrophy can cause ECG changes incl. tall R in V1. ⚠️ Check CK, look for weakness & systemic features.
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