Atrial fibrillation and left ventricular hypertrophy
Coarse and irregular baseline with absent P waves indicate atrial fibrillation. The irregular RR interval is also suggestive of atrial fibrillation. Deep S waves are seen in right precordial leads and tall R waves with inverted T waves in lateral leads indicate left ventricular hypertrophy. There is no significant ST segment depression, which we would have expected in systolic over load of the left ventricle. The poor progression of R waves in anterior leads could also be due to left ventricular hypertrophy, though an old anterior wall myocardial infarction cannot be ruled out. There is ST segment elevation which is upsloping, merging into tall T waves in leads V2 and V3, which goes along with left ventricular hypertrophy.