So let's do some cases.
A 52-year-old man comes to the emergency department complaining of shortness of breath whenever he walks.
He says he was once told he had high blood pressure
but he didn't particularly like his doctor so he never did anything about it.
His physical exam shows very impressive high blood pressure, a 190/108.
His heart rate is quite fast at 96 bpm.
And the rest of his physical exam shows signs of early heart failure.
He might have crackles at the base, his JVP -- his jugular venous pulse might be elevated
so there's some heart failure and is almost certainly due to untreated high blood pressure.
So, the clues here: he has dyspnea, shortness of breath, he has nasty untreated hypertension,
and there's sounds like there's some heart failure involved here probably from untreated hypertension.
And here's his cardiogram.
Take a look at it for a few minutes and see if you can identify the abnormalities.
So, notice first of all, big tall R wave in lead 1.
Notice deep S waves in the precordial leads V1, V2, V3
and you'll notice also abnormal ST segments and there's also increased voltage in V4 and V5.
All of these together says left ventricular hypertrophy with ST changes.
This suggests in fact quite severe left ventricular hypertrophy.
The diagnosis is left ventricular hypertrophy.
You'll notice also that the T waves are inverted in leads V5 and V6.
Also, part of this left ventricular hypertrophy with ST and T wave changes.