Late R wave transition

Late R wave transition occurs when the isoelectric chest lead is later than V4. This is also known as poor R wave progression or Clockwise Rotation. Signs of this pattern include if there isn’t a 3mm R wave by V3 or there is still a residual S wave in V6.

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ECG Library (16)

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In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Anterior ST elevation Hyperacute T waves Late R wave transition Pathological Q waves Premature ventricular complex Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
What happens when a patient with LAD OMI does not go immediately to the cath lab? 30223

This ECG is from an elderly woman who presented with chest pain.

This ECG shows ST elevation V2-4 with poor R progression and hyperacute T waves. The cause was an acute LAD occlusion.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Hyperacute T waves Late R wave transition Pathological Q waves Dr Smith's ECG Blog CC BY-NC
See what happens when hyperacute T-waves are missed 27537

This ECG is from a man in his 60s who presented with central chest pain that started while mowing the lawn, associated with diaphoresis, nausea and vomiting, on a background of hypertension and previous infarction.

In the ECGquest archives, this ECG has been tagged with: - 12-Lead Inverted T waves Late R wave transition Pathological Q waves Dr Smith's ECG Blog CC BY-NC
See what happens when hyperacute T-waves are missed – ‘baseline’ ECG 27622

This ECG is from a man in his 60s who presented with central chest pain that started while mowing the lawn, associated with diaphoresis, nausea and vomiting, on a background of hypertension and previous infarction. This was his prior ECG on file for comparison.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead High V1/V2 misplacement Hyperacute T waves Late R wave transition Terminal QRS distortion Acute Anterior MI Dr Smith's ECG Blog CC BY-NC
Prehospital OMI recognized immediately by a fantastic paramedic 26016

This ECG is from a woman in her 60s who presented with chest pain and feeling clammy, on a background of hypertension and high cholesterol. This was her first prehospital ECG.

In the ECGquest archives, this ECG has been tagged with: - Cardiac arrest 12-Lead Absent P waves Anterior ST depression Inferior ST depression Irregular Late R wave transition Lateral ST elevation Left Axis Deviation Acute Lateral MI ECG of the Week CC-BY-NC-SA
ECG of the Week – 26th March 2018 – Interpretation 18849

This ECG is from a man in his 40s who had a cardiac arrest out of hospital. He regained cardiac output on the way to the Emergency Department.

In the ECGquest archives, this ECG has been tagged with: - Chest pain 12-Lead Serial 12-lead Late R wave transition Dr Smith's ECG Blog CC BY-NC
Chest pain and a “normal” ECG – T= 1hr 10 min 17112