A 41-year-old man with history of lupus diagnosed at age 28 and a myocardial infarction at age 32 for which he was medically treated is complaining of angina and dyspnea for the past 6 months:

• Sinus rhythm
• Intraventricular conduction delay

Comment: Although the QRS morphology is similar to a left bundle branch block pattern, the deep S-wave in lead V6 (which may be secondary to the left axis and concomitant low positioning of lead V6) and Q-wave in lead I make this ECG more in keeping with a non-specific intraventricular conduction delay.