Scenario: This is a resting 12-lead electrocardiogram (ECG) from a 68-year-old man during his first annual physical examination with a new provider. He has no significant medical history, has a normal body weight, and takes a daily aspirin. Of note, he shares that he has not seen a provider since he was 60 years old because he has anxiety about seeing health care providers.

Normal sinus rhythm at 60 beats per minute with inferolateral ventricular strain pattern and premature ventricular contractions (PVCs) in a trigeminal pattern.

Despite the PVCs, it is important to note that the overall rhythm is sinus. This means that the dominant pacemaker is the sinoatrial (SA) node. Looking at the 10-second rhythm strip in lead II, at the bottom of the 12-lead ECG, it can be appreciated that the first 2 beats are sinus, each preceded by a...

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