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ECG changes - tall R wave in V1

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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The examination of the QRS complex ought to be finished with a specific look at V1, which should be mainly S waveform

If R is dominant then this may be caused by:

  • right bundle branch block
  • right ventricular hypertrophy
  • posterior MI
  • Wolf Parkinson White syndrome (type A). The latter condition is also characterised by delta waves, a shoulder or slurred upstroke in the QRS complex (1)
  • dextrocardia
  • Duchenne's muscular dystrophy
  • normal variant

Click here for example ECGs and further information


  • Joshi P (1990).Multiple Choice Questions for MRCP.2nd Edn. Butterworths.

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