The ECG of this 76-year-old hypertensive man is recorded at the office of his family MD during his yearly assessment:

• Sinus rhythm
  
• Left anterior fascicular block
  
• Left ventricular hypertrophy with repolarization abnormality
  

This patient had a longstanding history of hypertension, difficult to control, and mild stable angina on effort. The ECG shows typical findings of left anterior fascicular block. Voltage criteria for left ventricular hypertrophy are noted in the limb leads. Mild ST abnormalities in I and aVL have been present for several years and are unchanged. They may be due LVH and/or lateral ischemia.