A 55-year-old male of Asian descent presents for a first time appointment to a primary care office for an annual physical examination. He has no known medical history and is in his usual state of health. He denies any chest pain, dyspnea, syncope, lightheadedness, exercise intolerance, lower extremity edema or orthopnea. Vital signs are notable for a blood pressure of 142/92 mmHg and a heart rate of 86 beats per minute. Physical exam findings are notable for a soft 1/6 systolic murmur heard best in the bilateral upper sternal borders. Electrocardiogram is performed (Figure 1).
• Describe the ECG?
• What is the likely cause of the electrocardiogram findings?
• What is the next step in management?
• Does the patient need an inpatient or a continued outpatient evaluation?

Included in

Cardiology Commons