Why the study?
How can secondary R waves in right precordial leads be differentiated between normal subjects and patients with cardiac disease?
How can secondary R waves in right precordial leads be differentiated between normal subjects and patients with cardiac disease?
Recording ECG leads below V1 and V3R can help differentiate benign secondary R waves (which disappear) from pathological ones (which persist).
May support lower-lead ECG recording to distinguish benign from pathological secondary R waves; leaves open prospective validation before practice change.
Secondary R waves in leads V 1 or V 3R are definitely abnormal if the primiary R wave is high for the age group even though the R' is small; if the secondary R wave is more than 6 mm.; or if the R'/S ratio exceeds 1. Other patterns may be found both in patients with heart disease and in normal subjects. In the abnormal cases, the QRS changes persist in leads taken below but in line with V 1 and V 3R ; but in normal cases, the secondary R waves usually disappear in the lower leads.
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TAPIA et al. (1960) studied this question.
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