The ECG below is from a 79 year old man who has presented short of breath with acute pulmonary oedema. His past medical history includes HTN, T2DM and CKD.

Interpretation:

• Rate: 114
• Rhythm: sinus
• Axis: RAD (90-150) – a note on this later
• Intervals: PR 210, QRS 140 QTc 469 (Bazzett)
• Morphology: LBBB
• Summary: Sgarbossa negative LBBB
• Additional: +ve R in aVR -ve complex in aVL – these leads are swapped
• Additional: lead 1 is inverted
• Additional: Lead II and III are switched
• ?is this RA and LA reversal