Abstract
Tall lead V1 (tall RV1), defined as an R/S ratio equal to or greater than 1, is not
an infrequent occurrence in emergency department patients. This electrocardiographic
finding exists as a normal variant in only 1% of patients. Physicians should therefore
be familiar with the differential diagnosis for this important QRS configuration.
The electrocardiographic entities which can present with this finding include right
bundle branch block, left ventricular ectopy, right ventricular hypertrophy, acute
right ventricular dilation (acute right heart strain), type a Wolff-Parkinson-White
syndrome, posterior myocardial infarction, hypertrophic cardiomyopathy, progressive
muscular dystrophy, dextrocardia, misplaced precordial leads, and normal variant.
Various cases are presented to highlight the different causes of the tall RV1. (Am
J Emerg Med 2001;19: 504-513. Copyright © 2001 by W.B. Saunders Company)
Keywords
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D; use, select 'Corporate R&D; Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Electrocardiographic case. Differential diagnoses of tall R wave in V1. Acute infero-postero-lateral myocardial infarction.Singapore Med J. 1992; 33: 638-648
- Electrocardiographic tall R waves in the right precordial leads.J Electrocardiol. 1990; 23: 147-156
- Significance of a terminal R wave in lead V1 of the electrocardiogram.Am Heart J. 1978; 95: 702-706
- Marriott's Manual of Electrocardiography.in: Trinity Press, Orlando, FL1995: 64-67 (82-84, 86-88, 115-116, 148-151)
- Pearls and Pitfalls in Electrocardiography.in: ed 2. Williams & Wilkins, Baltimore, MD1998: 24-29 (134-137, 140-141)
- Electrocardiography in Clinical Practice: Adult and Pediatric.in: ed 4. W.B. Saunders Company, Philadelphia, PA1996: 54-69 (88-99, 121-154, 261-267, 281-295, 471-492)
- Electrocardiographic recognition of ventricular ectopic beats in lead V1—A preliminary report.Heart Lung. 1975; 4: 921-926
- Marriott's Practical Electrocardiography.in: ed 9. Williams & Wilkins, Baltimore, MD1994: 63-65 (83-85, 104-114, 154-171, 243-244, 311-322)
- Diagnosis of ventricular tachycardia from the 12-lead electrocardiogram.Cardiol Clin. 1987; 5: 511-525
- Wide-QRS complex tachycardia: Reappraisal of a common clinical problem.Ann Intern Med. 1988; : 109:905
- Emergency Electrocardiography.in: FL, Trinity Press, Naples,1997: 57-78
- Advanced Concepts in Arrhythmias.in: ed 3. MO, Mosby, St. Louis1998: 237-260 (283)
- Electrocardiographic manifestations: Aberrant ventricular conduction.J Emerg Med. 2000; 19: 363-367
- A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex.Circulation. 1991; 83: 1649-1659
- Ventricular tachycardia with classic triphasic morphology (rSR' pattern) in lead V1.Chest. 1980; 77: 666-668
- Posterior wall myocardial infarction.in: The 12 Lead Electrocardiogram. Blackwell Scientific Publications, Oxford, England1988: 176-180
- The tall R wave in lead V1 in posterior myocardial infarction: A reciprocal sign or a His-Purkinje conduction disturbance?.Pacing Clin Electrophysiol. 1989; 12: 1650-1659
- Acute Posterior wall myocardial infarction: Electrocardiographic manifestations.Am J Emerg Med. 1998; 16: 409-413
- Acute myocardial infarction with isolated ST-segment elevation in posterior chest leads V7-V9: “Hidden” ST-segment elevations revealing acute posterior infarction.J Am Coll Cardiol. 1999; 34: 748-753
- Prevalence and outcome of ST-segment elevation in posterior electrocardiographic leads during acute myocardial infarction.J Electrocardiol. 1999; 32: 275-278
- Value of leads V7-V9 in diagnosing posterior wall acute myocardial infarction and other causes of tall R waves in V1-V2.Am J Cardiol. 1997; 80: 508-509
- Serial changes in negative T wave on electrocardiogram in acute pulmonary thromboembolism.Int J Cardiol. 1999; 72: 65-72
- A case of extensive pulmonary embolism presenting as an acute myocardial infarction—Notes on its possible pathophysiology.Eur J Emerg Med. 1998; 5: 253-258
- A re-evaluation of electrocardiographic changes accompanying acute pulmonary embolism.Am J Med Sci. 1966; 251: 381-398
- Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: Diagnostic and initial therapeutic issues.Am J Emerg Med. 1999; 17: 705-714
- Pseudo myocardial infarction and pseudo ventricular hypertrophy ECG patterns in Wolff-Parkinson-White syndrome.Am J Emerg Med. 2000; 18: 802-806
- The Wolff-Parkinson-White syndrome: Diagnosis and treatment.Heart Lung. 1981; 10: 465-474
- Criteria for intraventricular conduction disturbances and pre-excitation.Am J Cardiol. 1985; 5: 1261-1275
- Electrocardiographic findings in patients with obstructive and nonobstructive hypertrophic cardiomyopathy.Circulation. 1978; 58: 402-408
- A distinctive electrocardiogram in muscular subaortic stenosis due to ventricular septal hypertrophy.Am J Cardiol. 1964; 14: 599-607
- Dominant R wave in lead V1.Heart Lung. 1998; 27: 352-353
- The distinctive electrocardiogram of Duchenne's progressive muscular dystrophy: An electrocardiographic-pathologic correlative study.Am J Med. 1967; 42: 179-188
Article Info
Publication History
Accepted:
February 28,
2001
Received:
February 11,
2001
Footnotes
*Reprints are not available.
**0735-6757/01/1906-0011$35.00/0
Identification
Copyright
© 2001 W.B. Saunders Company. Published by Elsevier Inc. All rights reserved.
