A patient in their early-30’s presents to the hospital with chest pain, dizziness and SOB for 2 hours. The dizziness is described as feeling light-headed. He denies vertigo, syncope, leg swelling, fever, cough or other complaints. He has no known medical history but does smoke tobacco.


Vital signs are normal. The physical exam is normal with clear lungs, no peripheral edema, and no nystagmus or cerebellar signs.

An ECG is done:

Computer Read: Sinus rhythm. Possible RV conduction delay, voltage for LVH. | Credit: Brady Pregerson, MD

What is the most likely cause of the ECG findings in this patient?

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