Scenario: During an annual physical examination, a healthy 55-year-old man who works as a long-haul truck driver had a routine 12-lead electrocardiogram (ECG) recorded. Overall, he had no complaints and was asymptomatic. His body mass index was within normal limits, and he was taking simvastatin for high cholesterol and lisinopril for high blood pressure (current blood pressure, 128/78 mm Hg).

Sinus rhythm at 85 beats per minute with first-degree atrioventricular (AV) block and premature ventricular contractions (PVCs) in a trigeminy pattern.

Trigeminy is a pattern of PVCs occurring in a series of 3 heart beats, either 2 normal sinus beats followed by a PVC (as in this example) or 1 normal sinus beat followed by 2 PVCs. Trigeminy is not common, is often transient, and can disturb the normal contraction and cardiac output of the heart because a premature impulse interrupts sinus rhythm. In this case, there are more...

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