This is an ECG from a 95 year old man who was recovering from an anterior-septal wall M.I.  Other clinical data for this patient has been lost, except that he suffered a new right bundle branch block during this M.I.  The ECG shows pathological Q waves in V1, V2, and V3, consistent with permanent damage (necrosis) in the anterior septal wall.  The ST segments in those leads are coved upward.  Even though the J points are not elevated, this ST segment shape suggests recent injury.  The classic RBBB pattern is present:  wide QRS, rSR' pattern in V1, and wide little s waves in I and V6.  It is not known why the overall voltage is low in this patient.