A 60-year-old woman with a 10 year history of scleroderma is presenting to the Clinic: 

• Sinus rhythm
• Left atrial enlargement
• Right axis deviation
• Right ventricular hypertrophy
• Non-specific ST and T abnormality

The patient had scleroderma with severe pulmonary hypertension (pulmonary artery pressure 105 mmHg) and hypoxia, requiring continuous oxygen supplement. The echocardiogram showed severe dilatation and hypertrophy of the right ventricle.