Many patients with left ventricular hypertrophy will have electrocardiograms that do not fulfill the various criteria discussed above. In these situations, it is very helpful to consider the clinical presentation and subtle ECG changes, particularly slight changes in QRS duration and minor repolarization changes and to raise the possibility of hypertrophy, even if the criteria are not strictly met. Examine the ECG shown here and determine which of the various criteria for left ventricular hypertrophy are fulfilled.