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Heart & Cardiology - Positive and Negative R waves in Lead III
Expert: David Richardson - 10/31/2009
Question
I am a 22 year old male, 5'10" and 165 pounds. I recently had an EKG recorded (I was the patient) and what I saw is somewhat baffling to me. In leads II and aVF the QRS complex is largely positive with a small S wave in lead II, but in lead III the QRS complex is mainly negative with the R wave measuring less than 1 mm and the S wave deflection measuring approximately 4 mm. This pattern is seen upon exhalation. Upon inspiration the QRS complex in lead III would 'transition' and it became almost entirely positive (R wave approx. 8 mm at its peak) and looked "normal" while the R wave deflection in leads II and aVF also increased. When I would exhale again the first pattern described resumed, and this continued with my respiratory pattern. Sinus arrhythmia noted but rate WNL and no other arrhythmia was observed. I am a Paramedic so I have some experience with EKG interpretation, but I have never seen this before. I am a 22 year old male if that changes/influences the interpretation. Can you help?
Thank you.
Answer
Dear Jon,
Only to say the EKG is normal. The changes with respiration are because the heart swings downward as the lungs expand and the diaphragm moves downward during inspiration.
Please write back if this note doesn't answer all your questions.
David Richardson
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