QRS axis is shifted to right and incomplete right bundle branch block pattern is seen in V1. This could mean a bifascicular block. Technical errors in recording by interchange of left arm and left leg leads have also to be considered. Since the clinical data is not available, this can only be clarified by a repeat ECG with meticulous attention to lead placement. Inverted P waves in leads III and aVF point to a different pattern of atrial activation. S1Q3 pattern with sinus tachycardia and incomplete right bundle branch block pattern would also make one suspect pulmonary embolism or similar forms of right ventricular overload.