Poor R Wave Progression
Editor-In-Chief: C. Michael Gibson, M.S., M.D. 
Synonyms and keywords: PRWP; poor R wave transition; delayed R wave transition; delayed transition; loss of R wave progression; loss of R waves
Poor R wave progression across the precordium refers to an electrocardiographic finding where the normal increase in R wave amplitude as one progresses from V1 to V6 is lost. Although non-specific, this finding is consistent with a prior anterior myocardial infarction.
The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 2–4 mm in leads V3 or V4 and/or there is presence of a reversed R wave progression, which is defined as R in V4 < R in V3 or R in V3 < R in V2 or R in V2 < R in V1, or any combination of these.
Poor R wave progression can be observed in the following settings:
- Faulty ECG recording technique
- Left bundle branch block
- Myocardial infarction
- Right and left ventricular hypertrophy
- Wolff–Parkinson–White syndrome
The EKG below shows sinus bradycardia at 47/min and poor R wave progression in the anterior chest leads with Q waves in leads V2 to V4 which are diagnostic of anterior myocardial infarction. Note that unlike the normal septal Q waves that start later in the progression of the chest leads and at the same time grow larger, the Q waves in this patient are abnormal because they are present in leads V2, V3, and V4 and are larger than those in V5 and V6. The cardiogram also shows abnormal T wave inversion and slight ST elevation in leads V1 to V3.
- ↑ Poor R-Wave Progression. By: Ross MacKenzie, MD. J Insur Med 2005;37:58–62