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, it 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:


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, Sixth Edition, Saunders, Philadelphia, 2008.