Abstract
The S1S2S3 pattern, in conjunction with right-dominant forces on a 12-lead electrocardiogram including a tall R-wave in lead V(1) (R:S >1), deep S waves in the left precordial leads V(5) and V(6) (R:S <1), QRS interval <120 ms, and right atrial enlargement (P-wave in lead II >2.5 mm), is highly specific for right ventricular dysfunction with pulmonary hypertension. (Level of Difficulty: Intermediate.).