This 72-year-old woman with a history of rheumatic heart disease and a mechanical mitral valve is admitted to the cardiac ward for treatment of congestive heart failure:

– Sinus rhythm, 88/min
– Right axis deviation
– Right ventricular hypertrophy with repolarization abnormality

Comments: The echocardiogram showed evidence of left and right ventricular hypertrophy, with severe pulmonary hypertension (right ventricular systolic pressure 90 mm Hg)