Early Repolarization ECG Review

Step2-Q28-PIC2Early repolarization is a common finding in young, healthy individuals. It appears as mild ST segment elevation that can be diffuse, however is more prominent in the precordial leads. The ST elevation in this setting appears like an elevated “J point”. 

While this is thought to be a benign finding, it needs to be distinguished from pathologic ST elevation that can be seen during acute myocardial infarction and pericarditis.

Note: The ECG changes of pericarditis must be distinguished from those of early repolarization. The ST elevation seen in early repolarization is very similar; diffuse and concave upward.

Three things may help to distinguish pericarditis from early repolarization:

  1. The ratio of the T wave amplitude to the ST elevation should be > 4 if early repolarization is present. In other words, the T wave in early repolarization is usually 4 times the amplitude of the ST elevation. Another way to describe this would be that the ST elevation is less than 25% of the T wave amplitude in early repolarization.
  2. The ST elevation in early repolarization resolves when the person exercises.
  3. Early repolarization, unlike pericarditis, is a benign ECG finding that should not be associated with any symptoms.

ECG Examples:

References:

1. Surawicz B et al. ACC/AHA recommendations for the standardization and interpretation of the electrocardiogram. Circulation. 2009;119:e235-240.

2. Chou's Electrocardiography in Clinical Practice: Adult and Pediatric, 6e

By Steven Lome