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Middle-Aged Man With an Incidental ECG Abnormality

Middle-Aged Man With an Incidental ECG Abnormality

A 44-year-old man presents for a preemployment physical examination. He is healthy, and he currently takes no long-term medications.


A detailed review of systems reveals no ischemic chest pain, dyspnea with exertion, orthopnea, or any other symptoms of either coronary artery disease (CAD) or heart failure. The patient does not smoke. He plays a round of golf weekly and participates in activities such as company softball games without any symptoms. He reports that his uncle “died of a heart attack” at the age of 54.


The patient weighs 72 kg (159 lb). Vital signs are normal, including blood pressure (108/72 mm Hg). Results of the cardiac and pulmonary examinations are normal.


The hemogram, serum chemistry values, and glucose level are all normal. Total cholesterol level is 159 mg/dL, with a low-density lipoprotein cholesterol level of 90 mg/dL and a high-density lipoprotein cholesterol level of 51 mg/dL. A chest radiograph is normal, and results of a purified protein derivative skin test are negative.

An ECG reveals normal sinus rhythm and a QRS axis of +60°. The only abnormality is a J-point elevation of 0.23 mL in the inferior leads. Troponin levels are normal. The ECG is essentially identical 5 weeks later.

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