ECG Review

Having New Chest Pain or Not?

By Ken Grauer, MD, Professor, Department of Community Health and Family Medicine, University of Florida. Dr. Grauer is the sole proprietor of KG-EKG Press, and publisher of an ECG pocket brain book.

Clinical Scenario

The ECG shown above was obtained from a 60-year-old man who was seen in the office. How would you interpret this tracing if you did not have more information? Is there cause for potential concern?


The rhythm is sinus at a rate of about 60/min. All intervals are normal, and the mean QRS axis is about +20°. There is no chamber enlargement. The interesting parts of the tracing are the QS complexes that are seen in leads V1 and V2, and which occur in association with slight but definite Jpoint ST segment elevation in leads V1 through V4. As suggested by the title of this ECG Review, the clinical key to interpretation of this tracing lies with the history. If this ECG was obtained from an otherwise healthy individual without any symptoms, it may well represent a normal variant in which the ST segment elevation seen was of no clinical significance. On the other hand, if the patient in question had symptoms that were possibly consistent with an acute coronary syndrome and no prior tracing was available for comparison — then one would have to be concerned that the QS complex in leads V1-2 and associated anterior ST segment elevation could represent ongoing acute infarction. Clinical correlation therefore means everything in the interpretation of this tracing. Repeating the ECG may also prove invaluable for determining whether the changes seen here are actively evolving or longstanding and stable.