CASE
A 49-year-old male presented to his primary care physician for a routine physical. He had no complaints and reported that he runs for 30 minutes daily, with no symptoms of chest pain, shortness of breath, or palpitations. He also denied any fatigue, dizziness, or syncope.
History The patient had hypertension and dyslipidemia but otherwise no significant medical history. He denied smoking, alcohol use, or drug use. He was taking an ACE inhibitor, lisinopril, 10 mg, and atorvastatin, 10 mg.
Physical examination He was well-built and athletic. Vital signs were within normal limits except for a heart rate of 41 beats per minute. Lungs were clear to auscultation. Cardiovascular examination revealed normal first and second heart sounds and no murmurs or gallops. There was no edema and no peripheral signs of heart failure. An ECG was obtained (Figure 1).
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