Secondary R Waves in Right Precordial Leads in Normal Persons and in Patients with Cardiac Disease

Abstract

Secondary R waves in leads V₁ 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 V₁ and V_3R; but in normal cases, the secondary R waves usually disappear in the lower leads.