This 56-year-old man with a longstanding history of chronic obstructive lung disease is admitted to the ICU with severe pneumonia:

• Sinus tachycardia, 110/min
• Right atrial enlargement
• Right axis deviation
• Right ventricular hypertrophy with repolarization abnormality (ST depression and negative T waves in the inferior leads and V1)

A previous echocardiogram showed evidence of right atrial enlargement, right ventricular hypertrophy, moderate tricuspid regurgitation, and pulmonary hypertension (right ventricular systolic pressure 80 mmHg).