Exercise Normalising Early Repolarisation
Report:
Sinus rhythm 54/min
Tall T waves
Widespread ST segment elevation
Probable early repolarisation normal variant
Comment:
This is a difficult tracing. Perhaps one should not be too hard on the computer in the preceding case!
The fact that ST elevation is present in both the chest and the frontal leads and that it includes lead V6 favour pericarditis over early repolarisation. However, prominent T waves are not a feature of pericarditis; further, PR segments appear normal and there is no tachycardia. Notching at J points where R waves are tallest, viz. V4-5, is characteristic of early repolarisation.
There is an impression of ST depression in lead 3 (which would bring ischæmia into consideration), but this is an illusion brought about by an initial dip of the T wave.
The trace remained unchanged over 24 hours (59a), practically excluding acute ischæmia. A stress test was done the same day (59b) and the patient sent home. Early repolarisation tends to resolve with exercise; also, over many years, with age.
59a.
59b.
60. 73 year old man with history of remote myocardial infarction. Whatâs the evidence on his ECG?
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