Your choice: Left ventricular hypertrophy + left anterior fascicular block
This electrocardiogram shows left ventricular hypertrophy and left anterior fascicular block. The characteristic features of left ventricular hypertrophy demonstrated here include increased voltage, reflected by the
tall R wave in aVL exceeding 11 mm,
ST-T abnormalities well seen in this lead as well as leads I, V5 and V6, a prolongation of the
QRS interval, and left atrial enlargement, reflected by the wide
P wave in lead II and the prominent negative P wave in lead V1. Left anterior fascicular block is manifested by left axis deviation of ≥ -45° and is reflected by the negative QRS in lead II with an
rS morphology in lead II.