This 51-year-old man, who had a left pneumonectomy 2 years ago, is in the Intensive Care Unit with pneumonia:

• Sinus tachycardia
• Right atrial enlargement
• Right ventricular hypertrophy with repolarization abnormality
• T wave abnormality, consider lateral ischemia

Comments: There are findings of right atrial enlargement and right ventricular hypertrophy. The biphasic P wave in lead I and the very tall positive P wave from V2 to V4 are due to displacement and rotation of the heart secondary to the total left pneumonectomy. The patient was admitted to the Intensive Care Unit with bronchopneumonia. He was severely hypoxic and required intubation and ventilation. The echocardiogram confirmed the marked displacement of the heart, right ventricular hypertrophy and pulmonary hypertension (90 mm Hg). Despite intensive therapy, the patient died two days later.