IJCS | Volume 32, Nº5, September/October 2019

548 Figure 1 - ECG-1: Sinus rhythm, heart rate of 90 bpm, P-wave axis + 55°, P-wave duration > 110 ms, P-wave voltage ≥ 2.5 mm in lead II, peaked, broad, bimodal, and plus-minus P-waves in lead V1, prolonged and bimodal P-wave in leads V 4 -V 5 , low QRS amplitude in lead V 1 contrasting with high QRS voltage in lead V 2 : indirect signs of right atrial enlargement (“Sodi-sign”), normal PR interval, extreme left axis deviation (QRS axis - 60°), rS pattern in the inferior leads, qRs in I, and qR in aVL: left anterior fascicular block. Precordial QRS transition displaced to the left, deep S-waves in leads V 5 -V 6 , rS pattern from V 1 to V 5 demonstrating severe right ventricular overload. Conclusion: Biatrial enlargement; biventricular overload with predominant right ventricular overload; left anterior fascicular block. Valle et al. Drug efficacy in acute Chagas myocarditis Int J Cardiovasc Sci. 2019;32(5):546-550 Case Report