When the QRS amplitude is high, it is usually due to one or more of several factors: an unusually large heart muscle mass (a big or thick heart), an unbalanced size of a ventricle, or a large heart in relation to the chest size or closeness to the chest wall. The lead direction is maximally parallel to the average direction of the QRS forces in that person.
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(2010). High R–Waves (3–Codes). In: The Minnesota Code Manual of Electrocardiographic Findings. Springer, London. https://doi.org/10.1007/978-1-84882-778-3_6
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DOI: https://doi.org/10.1007/978-1-84882-778-3_6
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