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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
Cause | Description | Clinical Significance |
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Right Ventricular Hypertrophy (RVH) | Increased muscle mass in the right ventricle leads to a prominent R wave in V1. | Commonly associated with conditions that cause pulmonary hypertension, such as chronic obstructive pulmonary disease (COPD), pulmonary embolism, and congenital heart disease. |
Posterior Myocardial Infarction | Infarction of the posterior wall of the left ventricle can cause a dominant R wave in V1 due to the loss of electrical activity in the posterior leads. | This is often accompanied by ST-segment depression and upright T waves in V1-V3, mimicking the appearance of right ventricular hypertrophy. |
Right Bundle Branch Block (RBBB) | Delayed conduction through the right bundle branch causes a delayed and prominent R wave in V1. | RBBB can occur in the setting of structural heart disease, ischaemia, or as an isolated finding in otherwise healthy individuals. |
Wolff-Parkinson-White Syndrome (WPW) | Pre-excitation of the ventricles through an accessory pathway can produce a dominant R wave in V1, especially in the presence of a left-sided accessory pathway. Usually Type A (posterior or lateral wall preexcitation) | WPW is associated with episodes of supraventricular tachycardia, and the ECG may also show a short PR interval and delta waves. |
Hypertrophic Cardiomyopathy (HCM) | Thickening of the interventricular septum can produce a dominant R wave in V1. | HCM is a genetic condition that may lead to heart failure and an increased risk of sudden cardiac death. |
Normal Variant | In some individuals, a dominant R wave in V1 may be a normal variant without any underlying pathology. | This is more commonly seen in young, healthy individuals and typically does not require further investigation if there are no other abnormalities. |
Dextrocardia | In this condition, the heart is positioned on the right side of the chest, which can cause a dominant R wave in V1. | Dextrocardia is often associated with mirror-image changes in the ECG, and the diagnosis is confirmed by imaging studies. |
Duchenne Muscular dystrophy and Myotonic dystrophy | Can cause a dominant R wave in V1. | Check CK and other clinical signs |