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A recent paper (Lloyd-Thomas, 1960) described the exercise electrocardiogram in healthy subjects, when experience was gained with certain changes that were natural in a tracing recorded in such cases following moderately strenuous exercise. The absence of certain other changes suggested that they might be identifiable with the effect of coronary arterial disease on the myocardium; and it was the purpose of the present investigation to test their usefulness in the diagnosis of cardiac pain when the clinical course and the changes in serial cardiograms at rest were known. Nature of the Investigation. 187 patients, aged 30-79 years, with classical cardiac pain were admitted to the investigation. All had shown during their period of observation at least one electrocardiographic tracing at rest that could not be regarded as normal. In many instances the abnormalities in the most pathological tracing were very obvious, while in others they were of the kind described as lesser signs in the papers of Evans and McRae (1952), Evans and Pillay (1957), or the S2S3 pattern (Davies and Evans, 1960).When an analysis was made of the most abnormal of the serial tracings in each case, it was found that 45 showed abnormal Q waves (associated with simultaneous significant inversion of the T wave in 28), 48 had significant T wave inversion, and 94 showed only lesser signs or the S2S3 pattern. Of the 94 cases in the last division, 4 were included solely because of changes affecting lead IIIR, namely the development of S-T depression or the development of a Q wave broader than 0 04 sec. or deeper than 3 mm., such findings being absent from lead III. The remaining 90 cases displayed abnormalities affecting the S-T segments or the T-U segments, inversion of U waves, or T waves that were of low voltage or blunted or bifid or with a terminable dip, or abnormal notching ofthe qRS complex of lead CR7.All of the cases with abnormal Q waves and all those with abnormal inversion of the T wave showed lesser signs or the S2S3 pattern either in different leads or in tracings recorded at another time.The presence of coronary arterial disease with naked-eye infarction of muscle was confirmed at necropsy in four cases. In two, the most abnormal resting records available had shown lesser signs and in two the tracings had shown abnormal inversion of the T wave, associated in one with abnormal Q waves.

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