History:

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.

Exam:

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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