Differential Diagnosis for Poor R Wave Progression on ECG
Single Most Likely Diagnosis
- Left Ventricular Hypertrophy (LVH): Poor R wave progression in leads V2, V3, and V4 can be seen in LVH due to the altered electrical activity and thickening of the left ventricular wall, which can lead to decreased R wave amplitude in these leads.
Other Likely Diagnoses
- Anterior Myocardial Infarction: Previous or current myocardial infarction in the anterior wall of the heart can lead to poor R wave progression due to scarring and altered electrical conduction.
- Left Bundle Branch Block (LBBB): LBBB can cause poor R wave progression in the anterior leads due to the delayed activation of the left ventricle.
- Chronic Obstructive Pulmonary Disease (COPD): COPD can lead to a change in the position of the heart within the thorax, potentially causing poor R wave progression due to the altered orientation of the heart's electrical axis.
Do Not Miss Diagnoses
- Acute Coronary Syndrome (ACS): Although it might not be the most common cause, ACS, including myocardial infarction, must be considered and ruled out due to its high morbidity and mortality if missed.
- Pulmonary Embolism: A large pulmonary embolism can cause right ventricular strain, which might indirectly affect R wave progression, and is a critical diagnosis not to miss due to its potential for severe consequences.
Rare Diagnoses
- Cardiac Amyloidosis: This condition can lead to altered electrical conduction and potentially poor R wave progression, though it is less common.
- Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC): Although primarily affecting the right ventricle, in advanced cases, it could potentially lead to changes in the ECG that might mimic poor R wave progression.
- Congenital Heart Diseases: Certain congenital heart diseases can lead to abnormal ECG patterns, including poor R wave progression, due to the anatomical and functional abnormalities of the heart.