Early repolarization: Difference between revisions
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*Mostly seen in healthy patients <50, less likely >50, unlikely >70 | *Mostly seen in healthy patients <50, less likely >50, unlikely >70 | ||
*Typical patient is male, black, athlete | *Typical patient is male, black, athlete | ||
*Shows diffuse ST elevation similar to pericarditis and STEMI | *Shows diffuse [[ST elevation]] similar to [[pericarditis]] and [[STEMI]] | ||
*Underlying pathophysiology poorly understood, however, it is a normally a benign process | *Underlying pathophysiology poorly understood, however, it is a normally a benign process | ||
==ECG Findings== | ==[[ECG]] Findings== | ||
*Widespread '''concave''' ST elevation more prominent in V2-V5, elevation of ≥0.1 mV in two adjacent leads | *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 | *Notching or slurring of the J point | ||
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==Early Repolarization Syndrome== | ==Early Repolarization Syndrome== | ||
*Early Repolarization is a benign finding with asymptomatic patients | *Early Repolarization is a benign finding with asymptomatic patients | ||
*Early Repolarization syndrome applies to patients with early repolarization along with symptomatic arrhythmias such as | *Early Repolarization syndrome applies to patients with early repolarization along with symptomatic arrhythmias such as [[ventricular fibrillation]] | ||
**This is a diagnosis of exclusion | **This is a diagnosis of exclusion | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ST elevation DDX}} | |||
==See Also== | ==See Also== | ||
Revision as of 18:51, 24 September 2019
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