ECG Case #46 - Question #1

A 72 year old male with a history of tobacco use presents with increasing shortness of breath and lower extremity edema. His blood pressure is 120/80, heart rate 80,  respirations 22, and oxygen saturation 88% on room air. His physical examination reveals decreased breath sounds with some expiratory wheezing, distant heart sounds without any murmurs/rubs/gallops, elevated jugular venous pressures with hepatojugular reflux, and 2_ lower extremity pitting edema bilaterally. Labs reveal an elevated CO2 level and slightly elevated BNP. An echocardiogram reveals normal left ventricular size and function. His ECG is below. What are the ECG findings?

RVH-Strain

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