ECG shows T wave inversion in lateral leads I, aVl, V5 and V6, suggestive of lateral wall ischemia. Deep S waves in V2 and tall R waves in V5 give an indication of left ventricular hypertrophy, though the S wave in V1 is not that deep and the R wave in V6 is not that tall. Ventricular rate is on the lower side indicating the possible use of drugs which suppress the sinus node. This combination could occurs in hypertensive individuals with coronary artery disease being treated with beta blockers or non-dihydropyridine group of calcium channel blockers. Lower heart rate can also be due to intrinsic sinus node dysfunction or sleep
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Lateral wall ischemia
T wave inversions are seen in leads I, aVL, V4 and V5, indicating lateral wall ischemia. The rate is below 60/ min and the rhythm is sinus (sinus bradycardia). Sinus rhythm is identified by upright P waves with normal PR interval in inferior leads, indicating a supero-inferior activation of the atria. In situs solitus, the sinus P waves are upright in lead I while it is inverted in situs inversus as the sinus node will be on the left side
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