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First positive deflection of the QRS complex
Normal R wave progression - increasing R wave amplitude across precordial leads
R waves usually transition (R/S=1) around V3/V4
R wave in V5 usually > R wave in V6 as V6 wraps across the chest laterally
Poor R wave progression - R wave < 3mm by lead V3
Reverse R wave progression - decreasing R wave amplitude across the precordial leads
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