In celebration of his 50th birthday, a man with no prior medical problems decides to run a marathon. He has run a few 5K and 10K events in the past 10 years, and he completed a half-marathon five years ago. Approximately three weeks into his training schedule, he completes a five-mile run; the next morning, he notes significant pain in the medial compartment of the right knee. After resting for two days, he begins running again; however, the pain returns and does not resolve. The pain remains localized to the medial right knee and is exacerbated by high-impact activities, such as climbing and descending stairs, as well as any movement requiring rotation or torque around the right knee. Despite the use of NSAIDs and icing, the pain does not resolve, and the patient presents to the sports medicine clinic. Medical history is negative for any previous knee trauma. Current medications include ibuprofen 800 mg four times daily. There are no known drug allergies. Family history is positive for adult-onset diabetes and valvular heart disease in both sets of grandparents. Both parents are alive and well. Social history shows no history of tobacco or illicit drug use. The patient reports having an occasional glass of wine with dinner. A 12-point review of systems is negative, with the exception of corrective lenses for presbyopia. Physical examination reveals a white man in no distress. The blood pressure is 108/66 mm Hg; pulse, 68 beats/min and regular; respiratory rate, 14 breaths/min; and temperature, 98°F. The lungs are clear; the cardiac exam reveals a regular rate and rhythm with no murmurs, rubs, or gallops. There is no jugular venous distention or peripheral edema. The abdominal exam is benign, and there are no neurologic deficits. Examination of the knee reveals very minimal swelling of the joint. The patient is able to fully extend the joint; however, flexion beyond 130° results in severe pain. The knee is stable to varus and valgus stress testing and to Lachman testing. There is fairly significant medial pain with any of the McMurray’s test maneuvers. An MRI of the right knee shows a significant tear in the posterior horn of the medial meniscus, as well as some chondromalacia of the patellofemoral joint. Given the patient’s age, an ECG is ordered as part of the preoperative workup for surgical repair of the right knee. The ECG reveals the following: pulse, 68 beats/min; PR interval, 156 ms; QRS duration, 88 ms; QT/QTc interval, 380/404 ms; P axis, 53°; R axis, –5°; and T axis, 18°. What is your interpretation of this ECG?
