ECG of the Month: Lung Mass and Abnormal Preoperative ECG

A 71-year-old woman with no history of cardiovascular disease is evaluated for elective thoracotomy with wedge resection of a left lower lobe lung mass. She is an active smoker with a chronic cough, but denies cardiac symptoms. She has no history of hypertension, diabetes, heart failure, or renal disease. A "routine" preoperative electrocardiogram (ECG) is obtained as shown (Figure 1), and she is referred for cardiology consultation to address the result.

Figure 1

Figure 1

You are asked to review the electronic health record and recommend next steps. The anesthesiology service notes that her Duke Activity Score Index estimates 9 METS of daily activity. You choose to do which of the following?

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