Scenario: At 35 years old, all commercial pilots are required by the Federal Aviation Administration to have an annual exam. Specifically, pilots must have a baseline electrocardiogram (ECG) at 35 and then an annual ECG after 40 years of age. You are scheduled on a flight to Reno, Nevada and this is your 52-year-old male pilot’s resting 12-lead ECG. Are you worried?

This 12-lead ECG shows normal sinus bradycardia at 55/min. There are many ways to approach the interpretation of an ECG including the following 10 considerations:

Widespread ECG screening of asymptomatic adults for inherited and acquired disease remains controversial because, although the ECG is a sensitive test and its negative predictive value is high, the low prevalence of disease makes screening on a population-wide basis plagued with problems. These problems include high false-positive rates, additional testing costs, potentially unnecessary interventions/therapies, and unwarranted...

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