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.

See also: QRS transition

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References

    Books
    • Hampton, J and Hampton, J (2019) - The ECG Made Easy, 9th edn, Elsevier
    • Thaler, MS (2003) - The Only EKG Book You'll Ever Need, 4th edn, Lippincott Williams and Wilkins

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?

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

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

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

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

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