A 51-year-old woman is followed in the respirology clinic because of severe idiopathic pulmonary fibrosis:

• Sinus rhythm
  
• Possible left atrial enlargement
• Right atrial enlargement
• Right axis deviation
• Right ventricular hypertrophy with repolarization abnormality

Idiopathic pulmonary fibrosis had been diagnosed 3 years earlier and had been rapidly progressive. Severe pulmonary hypertension had been proven (PA pressure 80 mmHg). The echocardiogram showed marked right ventricular hypertrophy. There are ECG findings of right atrial enlargement and right ventricular hypertrophy. Diffuse T wave abnormalities are common in patients with advanced  lung disease and hypoxia.