<prompt> A 60 year old marathon runner complains of dizziness episodes. On auscultation ejection systolic murmur is heard. ECG is done. Clinical diagnosis is?HTN with Atrial fibrillationLVH with Valvular Aoic stenosisRVH with Valvular Pulmonic stenosisBrugada Syndrome  <response>: The ECG shows hea rate of 50min with left axis. Patient is in normal sinus rhythm. QRS duration is normal. T wave inversion is noted in lead I, aVL and V5-V6 indicating possible ischemic changes. Depth of S wave in V1 20mm Height of R wave in V5 30mm SV1 RV56tallest R in either V5 or V6 35 mm is diagnostic of Left ventricular hyperophy Sokolov- Lyon criteria The low hea rate is explained by high vagal tone seen in marathon runners. 