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:

  • PR interval should be 120 to 200 milliseconds or 3 to 5 little squares

  • The width of the QRS complex should not exceed 110 milliseconds, less than 3 little squares

  • The QRS complex should be dominantly upright in leads I and II

  • QRS and T waves tend to have the same general direction in the limb...

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