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She’s sitting upright, gasping. Every breath a battle. The nurse checks his O₂ - 90%. You print the ECG… and instantly, your stomach drops. Lead V1 , a mountain. A dominant R wave towering over 7 millimetres. R/S ratio greater than one. V6 - the mirror opposite, a deep, plunging S wave. Axis? Pulled brutally to the right- 150 degrees. That’s not a normal heart. That’s a right ventricle fighting for its life. Then you spot the strain. ST depression. T-wave inversion in V1 to V4. It’s not an MI -
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