Scenario: A 78-year-old man came to the emergency department with a lacerated thumb that he injured while repairing his car. He had a coronary stent placed 8 years ago but did not remember what coronary artery was affected. He admits to having stable angina a few times a year that resolves with nitroglycerin and he sees his cardiologist regularly. He denies any cardiac symptoms, but because of his cardiac history, a resting 12-lead electrocardiogram (ECG) was obtained.

Normal sinus rhythm at 70/min with an intra-ventricular conduction defect (IVCD)

In 2009, the American Heart Association released an expert consensus statement addressing recommendations for the standardization and interpretation of the ECG in regards to intraventricular conduction disturbances. The document stated: “Because global data and data detailing the effects of age, gender, and race are still evolving, the committee recommends that for the present, a QRS duration of greater than 0.11 seconds in...

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