Abstract
ECG Challenge: A 77-year-old man presents for a preoperative evaluation before a hernia repair. He has a history of a previous myocardial infarction (6 years ago), and 2 years ago he underwent cardiac catheterization and a percutaneous coronary intervention because of drug-refractory angina pectoris. Since that time, he has been free of cardiac symptoms, but the surgeon requested a preoperative cardiac evaluation because of his history. Physical examination demonstrates normal heart sounds, but there is a grade 2/6 harsh midsystolic murmur heard at the base with faint radiation to the carotids. It is felt to represent aortic sclerosis. Paradoxical splitting of S2 is also appreciated. The ECG shows a slightly irregular rhythm. The first RR interval is slightly shorter (rate, 64 bpm) than the rest of the RR intervals, which are regular …
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