This ECG was obtained from a healthy 29-year-old man. It shows "benign early repolarization". It demonstrates the typical pattern of widespread ST elevation with a normal concave upward sloped ST segment. There are also prominent U waves in V2 through V4, and T wave inversions in the inferior wall leads. He was not complaining of any symptoms and, in fact, donated this ECG as an example of known early repolarization pattern. The other changes may represent normal variations for his age and gender. Early repolarization has long been thought to be a completely benign variant, and it is quite common in young people, especially athletic men. But new research suggests a possible link to future serious arrhythmias. For a discussion of research on this topic from the Journal of the American College of Cardiology, see this link. Research reported in the New England Journal of Medicine can be accessed at this link.
Benign early repolarization
This ECG was taken from a 60 year old man who was complaining of severe substernal chest pain, radiating to his left arm and a non-productive cough. There was some initial discussion among the EMS crew about the possibility of the ECG showing a "benign early repolarization" pattern because of the concave upward ("smiling") ST segments. They also considered a diagnosis of pericarditis, because the ST segments seem widespread. The baseline artifact makes it difficult to evaluate for PR segment depression or Spodick's Sign.
The patient's age (60 years) and troubling symptoms (chest pain radiating to the left arm) ruled out BEP for the paramedics. The ST segment elevations are pretty widespread - Leads V3, V4, V5, V6, I and II all show some STE. There are also "hyperacute" T waves in the leads with STE. There are ST abnormalities ranging from flattening of the shape to depression, but the bottom line is this patient is a 60-year-old man with substernal chest pain radiating down his left arm!
The patient was treated in the ambulance with chest pain protocols, and was transferred to a hospital with an interventional cath lab. The patient was conculusively diagnosed with an acute M.I. and underwent angioplasty.
This is a good ECG to demonstrate subtle changes when, combined with patient presentation, can help us diagnose a coronary event. It helps us emphasize that not all STEMIs will have dome-shaped, "tombstone" ST segments, and that patient symptoms, history, and age are important to consider.
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