An electrocardiogram (ECG or EKG) is a non-invasive test that records the electrical activity of the heart. Healthcare professionals use it to evaluate heart function and identify various heart conditions. One specific finding that may appear on an ECG is an “RSR pattern,” which refers to a particular shape of the electrical wave representing ventricular activity. This pattern can sometimes be a normal variation, but it can also indicate an underlying heart issue.
Understanding the RSR Pattern
The RSR pattern is a specific configuration seen within the QRS complex on an ECG. The QRS complex reflects the electrical impulse as it spreads through the heart’s ventricles, initiating their contraction. An RSR pattern involves an initial upward deflection (R wave), followed by a downward deflection (S wave), and then a second upward deflection (R prime, or R’). This gives the QRS complex a “rabbit ear” or notched appearance.
This pattern is primarily noted in the right precordial leads, specifically V1 and/or V2. The QRS interval is typically normal or mildly prolonged.
What Causes an RSR Pattern?
An RSR pattern on an ECG can stem from various causes, ranging from normal physiological variations to indicators of underlying heart conditions. Often, it is a benign finding, particularly when isolated in otherwise healthy individuals. For instance, it can be a normal variant due to the natural depolarization of the interventricular septum or a high placement of the V1 and V2 electrodes on the chest. This pattern is also commonly observed in athletes and individuals with a sunken chest, known as pectus excavatum.
However, an RSR pattern can also be associated with specific heart conditions. Incomplete Right Bundle Branch Block (iRBBB) is a frequent cause, where there is a delay in electrical conduction through the right bundle branch. While iRBBB is often considered a normal variant, especially in children, its presence requires consideration of the overall clinical picture. Other causes include complete Right Bundle Branch Block (RBBB), which involves a more pronounced conduction delay in the right bundle branch.
An RSR pattern may point to conditions such as Right Ventricular Hypertrophy (RVH), where the right ventricle’s muscle wall thickens, or congenital heart defects like Atrial Septum Defect (ASD). In rare instances, it might be a sign of more serious conditions such as Brugada Syndrome, an inherited electrical disorder of the heart, or arrhythmogenic right ventricular dysplasia (ARVD). An RSR pattern is an electrical sign, not a definitive diagnosis, and requires a comprehensive evaluation to determine its cause.
Interpreting Your RSR Pattern
The presence of an RSR pattern on an ECG does not automatically indicate a serious heart problem. Its significance varies greatly depending on the individual’s overall health, medical history, and any other findings on the ECG. If it is an isolated finding in an asymptomatic, healthy individual, it is often considered a normal variant and may not require further medical intervention or specific treatment. For example, in young people and athletes, an RSR’ pattern can be due to iRBBB or be a normal electrophysiological variant.
However, if the RSR pattern is accompanied by other symptoms, such as chest pain or fainting, or if other ECG abnormalities are present, further investigation may be necessary. Such investigations might include an echocardiogram to visualize the heart’s structure or additional specialized tests to assess electrical activity. A qualified medical professional, such as a cardiologist, should interpret ECG results and provide a definitive diagnosis. Self-diagnosis based solely on an RSR pattern is not advisable, as only a healthcare provider can determine the pattern’s true meaning in the context of an individual’s health.