You absolutely are . V 2 should definitely ' raise some red flags ' for you . But , remember , start the same with all of them P before every QRS Sinus rhythm ~ 82 bpm Deflection of I , aVF Left axis deviation A widened QRS , not typical BBB pattern Fascicular block QT RR QT is within normal limits Now you can start looking at ST segments Isoelectric except for V 1 , V 2 . What is concerning about an elevated ST segment ? The obvious choice is STEMI , but without reciprocal changes depressions , and having seen a lot of STEMIs , this doesn ' t fit the typical ' look ' for me . What this does look like is a Brugada patterncontentuploads 201410 brugada 2 . jpg and definitely in the right spot . Lacking clinical symptoms chest pain , pallor , diaphoresis , I am less concerned about MI , but this is about the point that the ED consults Cardiology .