This time, it's a 39 year old who presents from her internist's office after complaining of a 19-year history of palpitations which occur very sporatically. She had been seen by a cardiologist previously who workup was unrevealing: no family history of sudden death or heart disease, normal physical examination, "normal EKG" and "normal echo" (except for "flattening of her mitral valve on parasternal long axis view"). She was labeled as having "probable mitral valve prolapse" and administered Atenolol 25 mg daily, without effect. You, the ever-capable EKG aficionado, obtain this EKG:
Click image to enlarge
You smile, for the answer lies within. What do you tell her?