ECG Left ventricular hypertrophy ? What is your diagnosis.

A 43 year old female comes to JIPMER, Hospital, Pondicherry, India with chief complaints of dyspnoea on exertion since last two month with angina on exertion since last 15 days. On examination of the cardiovascular system there was ejection systolic murmur was present in the aortic area with radiation to the neck. S1 and S2 were present. Patient pulse was low volume and slow rising in character.ECG of patient is shown below

ECG ( Kindly click on the image to enlarge it)

Description of the ECG Sinus rhythm at 100 beats per minute, Left axis deviation (QRS is positive in lead I and negative in lead avF), left atrial enlargement(See deep negative P wave in lead V1), Left ventricular hypertrophy with left ventricular strain pattern was present ( Kindly see lead V1,V2, V5,V6, I, avL, and calculate the voltage of the QRS) ST segment depression with T wave inversion in lead I,avL, V4-V5 suggestive of left ventricular systolic strain pattern.

Patient underwent echocardiography which was suggestive of severe concentric Left ventricular hypertrophy with severe calcific aortic stenosis. Due to calcification it was difficult to differentiate whether it was bicuspid or tricuspid aortic valve. Presently patient is admitted is JIPMER Cardiology ward and she is planned for Aortic valve replacement.