ECG Atlas

Tall R wave in V1

Vigneshvarprashanth Umapathy*

Resident Internal Medicine, Kauvery Hospital, Tennur, Trichy, India

*Correspondence: [email protected]

  (1) Misplaced leads – Leads V1 and V6 interchanged

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(2) Right ventricular hypertrophy (RVH)

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(3) Pulmonary embolism causing right ventricular hypertrophy; ‘S1Q3T3’ pattern can also be seen

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(4) Right bundle branch block (RBBB) 

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RBBB with typical RSR’ pattern in V1

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(5) Left to right shunt – A 2-year-old baby with a perimembranous ventricular septal defect (VSD) 

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(6) Left to right shunt – A 1-year-old baby with a large atrial septal defect (ASD) 

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(7) A 20-year-old boy with Duchenne Muscular Dystrophy

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(8) A 23-year-old asymptomatic gentleman who was found to have dextrocardia during health checkup

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(9) Posterior wall myocardial infarction – A 69-year-old gentleman with history of triple vessel disease – S/P CABG, presented with chest pain and breathlessness

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(10) WPW syndrome type A

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(11) Hypertrophic cardiomyopathy 

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Causes of Tall R wave in V1

1 Lead misplacement
2 Normal in paediatric age
3 Right ventricular hypertrophy (Pulmonary embolism, left to right shunt)
4 Right bundle branch block
5 Posterior myocardial infarction
6 Wolff-Parkinson-White (WPW) type A
7 Dextrocardia
8 Hypertrophic cardiomyopathy
9 Dystrophy (Myotonic dystrophy, Duchenne muscular dystrophy)

AcknowledgementI sincerely thank respected consultant doctors S. Aravinda Kumar, G. Dominic Rodriguez, Ivan A Jones, Mani Ram Krishna for their guidance and contribution with the ECGs. I also thank my colleague resident doctors Reshma Raju, Praneetha, Sai Soundharya and cardiology DMO Dr. Priyanka for their valuable contribution.

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Dr. Vigneshvarprashanth Umapathy

Resident Internal Medicine

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