23-11: Early Repolarization

ECG Findings

• ST elevation, usually in the anterior leads, with a concave upward morphology

• J-point elevation, but usually less than one-third the total height of the T wave

• Terminal QRS notching

• Large, asymmetric T waves

Pearls

1. This is generally considered a normal variant and is especially common in young healthy males. However, recent studies have shown some increased susceptibility to sudden cardiac death over the long term.

2. Significant Q waves and/or reciprocal ST-segment depression in other leads should not accompany early repolarization. If present, they strongly suggest ischemia as the cause for the ST elevation.

3. The changes seen in early repolarization are static; hence, repeat ECG can be helpful. If dynamic changes are seen, suspect myocardial ischemia.