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Dominant R Wave in aVR

Dominant R wave in aVR ECG lead

Limb Leads and R Wave
Pathological R Wave
ECG and Dominant R Wave in aVR
Causes of Dominant R in aVR

Limb Leads and R Wave

Electrical vector, mechanism of R wave amplitude and QRS complex

Limb leads (I, II, III, aVF, aVR, aVL)

View the heart in the frontal plane

The ventricles are activated in the following order:

Ventricular septum (V_S - septal vector)
Left and right ventricles (V_M - main vector)
Base of the left ventricle (V_T - terminal vector)

The main cardiac vector (V_M) points

From lead aVR
Almost directly to lead II

where it creates the highest R wave

Dominant R Wave in aVR

Requires increased attention
Because it indicates extreme rotation of the main vector

towards lead aVR

Pathological R Wave

Dominant R wave in aVR and main electrical vector depolarization in ECG leads

Physiologically, the main vector points in 3D space

From lead aVR (Negative S wave, Q wave)
To the lateral leads (aVL, I, V5, V) (Dominant R wave)

Following R wave conditions require increased attention:
Dominant R in V1

The R wave in lead V1 should not be dominant

Dominant R in aVR

The R wave in lead aVR should not be dominant

Reduced progression of the R wave

The height of the R wave does not increase from V1 to V5

QRS Alternans

The height of the R wave changes from beat to beat

ECG and Dominant R Wave in aVR

Dominant R in aVR

R wave ≥ S wave

Ventricular Tachycardia

Causes of Dominant R in aVR

Ventricular Tachycardia
Tricyclic Antidepressants (Intoxication)
Incorrectly Placed Electrodes (left and right arm)
Dextrocardia
Pulmonary Embolism

Ventricular Tachycardia

Ventricular Tachycardia

Extremely wide QRS > 0.16s
Dominant R wave in aVR

Dominant R wave in aVR

There is an ectopic focus in the ventricles that generates impulses
In this case, the focus is located somewhere in the apex of the heart and the vector from the focus points

Toward the upper leads aVR and V1 (Positive R wave)
From the lower leads (II, III, aVF) (Negative Q wave)

The aVR lead is used for differential diagnosis of ventricular tachycardia

ECG tricyclic antidepressants overdose, side effects, dominant r wave avr lead

Tricyclic Antidepressants (Intoxication)

Depression affects about 20% of women and 10% of men
Intoxication with antidepressants produces the following on the ECG:

Dominant R wave in aVR
rSR configuration in aVR (and terminal R > 3mm)
Widening of the QRS complex

Dextrocardia

In dextrocardia, the heart and the cardiac axis are deviated to the right:

Dominant R wave in aVR
Dominant Q wave in lead I

The progression of the R wave is not maintained
Dominant R wave in aVR

The main vector in dextrocardia points from lead I and towards lead aVR

ECG dominant r aVR and lead misplacement, right left arm

Swapped ECG Leads (Left and Right Arm)

If you swap the ECG leads on the arms of the patient
A dextrocardia appearance in the limb leads will occur

Dominant R in aVR, Dominant S in lead I

However, the progression of the R wave in the precordial leads will be maintained
- This is a key sign that it is not dextrocardia
Dominant R wave in aVR (since it is actually the aVL lead)

Correctly Placed Limb ECG Leads

This is an ECG from the previous patient after correctly placing the ECG leads on the left and right arm
Note the normalization of QRS complexes in the limb leads

Acute Pulmonary Embolism

Right Bundle Branch Block

Wide QRS > 0.12s
Rsr in V1 (right bunny ear should be higher - rsR, but the axis is extremely deviated to the right)

Acute pulmonary embolism also creates the triad S1 Q3 T3

Negative S (in lead I)
Deep Q (in lead III)
Negative T (in lead III)

Dominant R wave in aVR

When the right side of the heart is overloaded, the heart rotates to the right, and the vector points towards lead aVR
Extreme right axis deviation +180°

Pathological Q in lead III > 3mm

In aVR and lead III

Such deep Q waves can also occur in healthy individuals and may not indicate pathology

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers

Home /

Dominant R Wave in aVR

Dominant R wave in aVR ECG lead

Limb Leads and R Wave
Pathological R Wave
ECG and Dominant R Wave in aVR
Causes of Dominant R in aVR

Limb Leads and R Wave

Limb leads (I, II, III, aVF, aVR, aVL)

View the heart in the frontal plane

The ventricles are activated in the following order:

Ventricular septum (V_S - septal vector)
Left and right ventricles (V_M - main vector)
Base of the left ventricle (V_T - terminal vector)

The main cardiac vector (V_M) points

From lead aVR
Almost directly to lead II

where it creates the highest R wave

Dominant R Wave in aVR

Requires increased attention
Because it indicates extreme rotation of the main vector

towards lead aVR

Pathological R Wave

Physiologically, the main vector points in 3D space

From lead aVR (Negative S wave, Q wave)
To the lateral leads (aVL, I, V5, V) (Dominant R wave)

Following R wave conditions require increased attention:
Dominant R in V1

The R wave in lead V1 should not be dominant

Dominant R in aVR

The R wave in lead aVR should not be dominant

Reduced progression of the R wave

The height of the R wave does not increase from V1 to V5

QRS Alternans

The height of the R wave changes from beat to beat

ECG and Dominant R Wave in aVR

Dominant R in aVR

R wave ≥ S wave

Ventricular Tachycardia

Causes of Dominant R in aVR

Ventricular Tachycardia
Tricyclic Antidepressants (Intoxication)
Incorrectly Placed Electrodes (left and right arm)
Dextrocardia
Pulmonary Embolism

Ventricular Tachycardia

Ventricular Tachycardia

Extremely wide QRS > 0.16s
Dominant R wave in aVR

Dominant R wave in aVR

There is an ectopic focus in the ventricles that generates impulses
In this case, the focus is located somewhere in the apex of the heart and the vector from the focus points

Toward the upper leads aVR and V1 (Positive R wave)
From the lower leads (II, III, aVF) (Negative Q wave)

The aVR lead is used for differential diagnosis of ventricular tachycardia

Tricyclic Antidepressants (Intoxication)

Depression affects about 20% of women and 10% of men
Intoxication with antidepressants produces the following on the ECG:

Dominant R wave in aVR
rSR configuration in aVR (and terminal R > 3mm)
Widening of the QRS complex

Dextrocardia

In dextrocardia, the heart and the cardiac axis are deviated to the right:

Dominant R wave in aVR
Dominant Q wave in lead I

The progression of the R wave is not maintained
Dominant R wave in aVR

The main vector in dextrocardia points from lead I and towards lead aVR

Swapped ECG Leads (Left and Right Arm)

If you swap the ECG leads on the arms of the patient
A dextrocardia appearance in the limb leads will occur

Dominant R in aVR, Dominant S in lead I

However, the progression of the R wave in the precordial leads will be maintained
- This is a key sign that it is not dextrocardia
Dominant R wave in aVR (since it is actually the aVL lead)

Correctly Placed Limb ECG Leads

This is an ECG from the previous patient after correctly placing the ECG leads on the left and right arm
Note the normalization of QRS complexes in the limb leads

Acute Pulmonary Embolism

Right Bundle Branch Block

Wide QRS > 0.12s
Rsr in V1 (right bunny ear should be higher - rsR, but the axis is extremely deviated to the right)

Acute pulmonary embolism also creates the triad S1 Q3 T3

Negative S (in lead I)
Deep Q (in lead III)
Negative T (in lead III)

Dominant R wave in aVR

When the right side of the heart is overloaded, the heart rotates to the right, and the vector points towards lead aVR
Extreme right axis deviation +180°

Pathological Q in lead III > 3mm

In aVR and lead III

Such deep Q waves can also occur in healthy individuals and may not indicate pathology

Sources

ECG from Basics to Essentials Step by Step
litfl.com
ecgwaves.com
metealpaslan.com
medmastery.com
uptodate.com
ecgpedia.org
wikipedia.org
Strong Medicine
Understanding Pacemakers