diagnosis is LVH. the changes are, tallest 'R'wave & deepest 'S'wave >40mm tall'R' wave in aVL LAD ST depression & T inversion in V4-V5 ST elevation in V1-V3 (this is not due to MI, but due to deep S wave- appropriate discordance) 'U' wave in V1-V3 slightly prolonged QRS complex duration (due to interventricular conduction delay)