Case 255

Medical history

A female patient, 60-year-old, sought care by a cardiologist requesting release for physical activity. Sedentary, asymptomatic, presented with hypercholesterolemia for 5 years, controlled with Enalapril, Hydrochlorothiazide and Simvastatin. Positive family history for coronary artery disease (CAD). Physical examination: good general condition, overweight (BMI: 25.6), BP: 140/80 mmHg, HR: 88 bpm, regular heart rate, normal heart sounds, no murmurs. Exercise testing was then required. Pre-test score for CAD - Morise = 12 (intermediate probability).

Based on the clinical history and the presented image (electrocardiographic tracings), what is the alteration presented by the patient and the best approach to be taken?

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