Left ventricular hypertrophy with strain pattern

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Tall R waves in V5 and V6 with ST segment depression and T wave inversion signify left ventricular hypertrophy (LVH) with strain. LVH with strain pattern occurs in systolic overload of the left ventricle as in aortic stenosis, systemic hypertension and hypertrophic cardiomyopathy. Negative P waves in V1 suggest left atrial overload. This is as a consequence diastolic dysfunction of the left ventricle and elevation of end diastolic pressure, transmitted backwards to the left atrium.