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Consider the following differentials when dealing with tall R-waves in lead V1:
Acute RV strain (PE)
Right ventricular hypertrophy (RVH- e.g. COPD, Pulmonary HTN, muscular dystrophy, etc.)
Na+ channelopathies (e.g TCA toxicity)
Hyperkalemia
Posterior MI
Incomplete/Complete RBBB
Hypertrophic cardiomyopathy
Dextrocardia, situs inversus
Ventricular beats/ectopy
Misplaced precordial lead
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