There are six parts to this answer

1. What best explains all of the abnormalities in this ECG? Right ventricular hypertrophy
2. Does the ECG play a role in immediately establishing a differential for the patient's problem? Yes, it allows for expeditious diagnosis and appropriate treatment

46 year old man with right shoulder pain and dyspnea. History of alcoholism. No prior cardiopulmonary disease history.

Vent. rate 110 bpm
PR interval 136 ms

QRS duration 90 ms
QT/QTc 356/481 ms

P-R-T axes 58 141 3