ECG in a child with a moderate VSD associated with considerable left-to-right shunting

ECG obtained in a child with a moderate VSD associated with clinically significant left-to-right shunting. There are tall R waves (>25 mm) in leads V5 and V6 consistent with left ventricular hypertrophy. In addition, a right bundle branch pattern (Rsr') is seen in leads V1 and V2, suggesting intraventricular conduction delay.