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 a 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
- Metabolic
- Drugs of abuse (eg, cocaine, crack, meth)
- Hyperkalemia (only leads V1 and V2)
- Hypothermia ("Osborn J waves")
- Medications