Scenario: This electrocardiogram (ECG) is from a 74-year-old man, a “direct” admission to the cardiac telemetry unit to rule out acute coronary syndrome after being seen by his primary care provider Monday morning. The patient described having experienced increased weakness and shortness of breath for the past week. He reported having had chest pain on Friday night, but waited to seek care because it resolved and he was “going to see [his] doctor on Monday.” His medical history includes coronary artery disease, a stent 6 years earlier in the right coronary artery, hypertension, diabetes, and glaucoma. He takes the following medications: aspirin, metoprolol, lisinopril, atorvastatin, and latanoprost eye drops. His vital signs are within normal limits and he is free of chest pain but states that he is still short of breath. A prior 12-lead ECG is not currently available.

Sinus rhythm, first-degree atrioventricular block, intraventricular conduction delay,...

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