Early repolarization

Background

• Mostly seen in healthy patients <50, less likely >50, unlikely >70
• Typical patient is male, black, athlete
• Shows diffuse ST elevation similar to pericarditis and STEMI
• Underlying pathophysiology poorly understood, however, it is normally a benign process

ECG Findings

• Widespread concave ST elevation more prominent in V2-V5, elevation of ≥0.1 mV in two adjacent leads
• Notching or slurring of the J point
• ST elevation is <25% of the T wave height in V6
• No reciprocal ECG changes or ST depressions (unless in aVR or V1)
• ST changes stable over time

Early Repolarization Syndrome

• Early Repolarization is a benign finding with asymptomatic patients
• Early Repolarization syndrome applies to patients with early repolarization along with symptomatic arrhythmias such as ventricular fibrillation
  • This is a diagnosis of exclusion

Differential Diagnosis

ST Elevation

• Cardiac
  • ST-segment elevation myocardial infarction (STEMI)
  • Post-MI (ventricular aneurysm pattern)
  • Previous MI with recurrent ischemia in same area
  • Wellens' syndrome
  • Coronary artery vasospasm (eg, Prinzmetal's angina)
  • Coronary artery dissection
  • Pericarditis
  • Myocarditis
  • Aortic dissection in to coronary
  • Left ventricular aneurysm
  • Left ventricular pseudoaneurysm
  • Early repolarization
  • Left bundle branch block
  • Left ventricular hypertrophy (LVH)
  • Myocardial tumor
  • Myocardial trauma
  • RV pacing (appears as Left bundle branch block)
  • Brugada syndrome
  • Takotsubo cardiomyopathy
  • AVR ST elevation
• Other thoracic
  • Pneumomediastinum
  • Pneumothorax
  • Pulmonary embolism
• Metabolic
  • Drugs of abuse (eg, cocaine, crack, meth)
    • Cocaine chest pain
  • Hyperkalemia (only leads V1 and V2)
  • Hypothermia ("Osborn J waves")
• Medications
  • Tricyclic (TCA) toxicity
  • Digoxin

See Also

• ECG (Main)
• In-Training Exam Review