Early repolarisation
Benign Early Repolarisation (BER)
Interpretation of the ST segment is very much dependent on the clinical scenario:
- upward ST concavity in asymptomatic patient may be benign early repolarisation
- upward ST concavity in young patient with pleuritic chest pain may be pericarditis
- upward ST concavity in older patient with chest pain may be MI
but beware!! see warning below…
| •common in young, less common >50yo and rare in >70yo | |
 | •ST elevation <25% height of T wave |
 | •T wave is usually peaked and asymmetrical •ST and ascending element of T wave form a smooth curve whereas descending T wave is usually steeper |
 | pericarditis vs BER •ST/T wave ratio is greater •ST changes are more widespread vs primarily precordial •PR depression vs none |
There is some debate about the benign nature of Early Repolarisation.
There appears to be an increased incidence of sudden cardiac death especially in some
Early repolarization characteristics associated with SCD include:
- high amplitude J-point elevation - especially >0.2mV
- horizontal and/or downsloping ST segments
- inferior and/or lateral leads location
Subtle ant MI vs normal variant ST elevation
Aslanger modification of 4 variable formula:
(RAV4 + QRSV2) - [(QT in mm) + STE60V3); a value < 12 is indicative of LAD occlusion
- R amplitude in V4
- QRS amplitude in V2
- QT - in mm
- STE60V3 - ST elevation in mm at 60ms point (1mm = 40ms)
References include:
https://litfl.com/benign-early-repolarisation-ecg-library/
Early repolarisation syndrome - a cause of sudden death 2015
Distinguishing between ant MI and normal variant ST elevation