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.





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.