Everybody knows that smoking is bad for lungs.

  It is also known that ECG abnormalities usually emerge when a smoker developes

      Chronic Obstructive Pulmonary Disease (COPD).

  However, what happens if a smoker has not developed COPD, yet.

      Will there still be an ECG abnormality to suggest that he/she is a chronic smoker?

  Yes, still there is an ECG finding which strongly suggests that a person is a chronic smoker.

      It is
P wave verticalization.

  Your new patient enters your outpatient clinic with his/her recently recorded ECG.

  You see that
the P wave axis is > 60 degrees with no additional ECG abnormality.

  You should first ask your patient: "Do you smoke?". Frequently, the answer will be "Yes".

  Remember that this finding is neither 100% sensitive nor 100% specific for smoking.

  However, it frequently works. Try it, and you will see that it works in most smokers.

  P wave verticalization is the earliest ECG abnormality to develope in chronic smokers.

  Of course the ECG may show additional abnormalities when the patient developes COPD.

References (including links to free full-text articles)

  Am J Cardiol 2012;109(7):1046-1049.

  Clin Cardiol 1999;22(3):226-228.

  Acta Inform Med 2013;21(2):127-128.

  Int J Chron Obstruct Pulmon Dis 2013;8:245-250.

  Tuberk Toraks 2013;61(1):38-42.

ECG 1. The above compact ECG is from a 59 years-old man.
He does not have COPD. His ECHOcardiogram was also normal. He does not have coronary artery disease.
However, his
P wave axis is +69 degrees. This man is a chronic smoker.

ECG 2. The above compact ECG is from a 19 years-old man.
He does not have COPD. His ECHOcardiogram was normal.
However, his
P wave axis is +64 degrees. This young man is also a chronic smoker.

ECG 3. The ECG above belongs to a 58 years-old diabetic, hypertensive man.
He has coronary artery disease, old myocardial infarction and left ventricular systolic dysfunction (EF 38%).
He had undergone coronary artery bypass grafting surgery 15 years ago.
In the last 2 years, stents were implanted in his Cx and LAD coronary arteries.
He still has significant several coronary artery stenoses which were not suitable for stenting.
P wave axis is +80 degrees. He is a chronic smoker and still continues smoking.
ECHOCardiography showed left ventricular systolic dysfunction but the cardiac chamber dimensions were normal.
P wave verticalization in the above ECG confirms the patient's confession about smoking. :)

Click here for a more detailed ECG