Poor R Wave Progression (PRWP)

Poor R Wave Progression Overview

Poor R-wave progression (PRWP) is a common ECG finding that is often inconclusively interpreted as suggestive, but not diagnostic, of anterior myocardial infarction (AMI).

PRWP is defined by R wave height ≤ 3 mm in V3.


Causes of PRWP

The major causes associated with PRWP include:


ECG Examples

Example 1

ECG PRWP

Poor R wave progression secondary to prior anteroseptal MI


Example 2

Leads-V1-and-V3-reversed 2

Poor R wave progression due to electrode misplacement (leads V1 and V3 reversed)


Related Topics


References

  • Zema MJ, Kligfield P. ECG poor R-wave progression: review and synthesis. Arch Intern Med. 1982 Jun;142(6):1145-8. [PMID 6212033]

LITFL Further Reading


Advanced Reading


ECG LIBRARY 700

ECG LIBRARY

Electrocardiogram

Posted by Dr Ed Burns

Dr Ed Burns . Emergency Physician in Pre-hospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education. Ed is the force behind the LITFL ECG library | + Edward Burns | @edjamesburns

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