This 65-year-old man with a significant smoking history is admitted to the ICU with pneumonia and severe hypoxemia requiring intubation:

• Atrial tachycardia, 174/min
• Right axis deviation
• rSR’ pattern in V1, consider right ventricular conduction abnormality
• A diagnosis of incomplete right bundle branch block (iRBBB) has not been made because the QRS  complex is narrow (80 msec)
• Possible right ventricular hypertrophy

The patient was found to have pulmonary hypertension and right ventricular hypertrophy.