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

Poor R wave progression secondary to prior anteroseptal MI

Example 2

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

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

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Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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