A 76-year-old retired physician came to the clinic for a medical check-up. He had never experienced any serious medical problem and had no history of heart disease. His physical examination was unremarkable. A chest x-ray was ordered, revealing prominence of the right heart border in the area of the ascending aorta, which was not seen on an old x-ray taken 7 years earlier. His electrocardiogram (ECG) revealed some irregularities (Figure 1).

Questions: Does the ECG show any specific heart disease? How do you explain the loss of anterolateral R-wave forces? Is it a “Q-wave equivalent” and a marker of previous silent myocardial infarction (MI) in this patient?