II. Epidemiology

  1. Prevalence: 5% of general population

III. Risk Factors

  1. Young men
  2. African american
  3. Athletes
  4. Bradycardia

IV. Signs

  1. Characteristics
    1. ST segment elevation with a concave upwards appearance (Smiley appearance)
    2. Contrast with the convex upwards appearance (Frown appearance) of an acute coronary event
  2. Distribution
    1. Precordial leads (especially V1 to V3)
  3. Asociated findings
    1. J Wave
      1. Notch at the end of the QRS Complex

V. Precautions: Red Flags

  1. Reciprocal ST depression
    1. Casts doubt on Early Repolarization as cause of ST Elevation
    2. Suggests coronary cause of ST Elevation

VI. Interpretation: Studies with mixed results on prognosis

  1. Early Repolarization has been long considered a benign finding until 2008
  2. Studies in 2008 suggested possible connection between Early Repolarization and sudden Cardiac Arrest
    1. If risk is increased it appears to manifest in the longterm (5-30 years of follow-up)
    2. Haissaguerre (2008) N Engl J Med 358(19): 2016-23 [PubMed]
  3. Large study in 2011 showed no increased risk of Sudden Cardiac Death
    1. However, study sample was skewed to older, white patients
    2. More typical cohort of concern would be younger african american patients described above under risk factors
    3. Uberoi (2011) Circulation 124(20): 2208-14 [PubMed]

VII. Prognosis

  1. If Early Repolarization increases Sudden Cardiac Death, the risk is a longterm risk (over as much as 30 years)
    1. Manage emergency department patients based on their presenting symptoms (e.g. Syncope)
    2. Asymptomatic Early Repolarization incidently found on EKG can be addressed on a routine basis
      1. Aggressive measures (e.g. AICD) are not indicated in asymptomatic patients
  2. Early Repolarization associated risk of idiopathic Ventricular Fibrillation or early cardiac death
    1. Associated with 4-10 fold increased risk of Sudden Cardiac Death (10 year risk)
    2. Incidence overall: 3.4 per 100,000
    3. Incidence if J Wave present (esp. >2mm in inferior leads): 11 per 100,000
    4. Benito (2010) J Am Coll Cardiol 56(15): 1177-86 [PubMed]

VIII. References

  1. Mattu and Herbert in Majoewsky (2012) EM:RAP 12(3): 4
  2. Grauer (2001) 12 Lead EKGs, 2nd ed, KG/EKG Press, Gainesville, Florida

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Ontology: Early repolarization (C1997354)

Definition (NCI_CDISC) An electrocardiographic finding of J point and ST segment elevation in the absence of other signs of acute ischemia or pericarditis.
Definition (NCI) An electrocardiographic finding of J point and ST segment elevation in the absence of other signs of acute ischemia or pericarditis. (CDISC)
Concepts Finding (T033)
SnomedCT 428417006
English Early repolarization (finding), ERP, Early Ventricular Repolarization, Early Repolarization Pattern, Early Repolarization, Early repolarization, EARLY REPOLARIZATION
Spanish repolarizaciĆ³n temprana (hallazgo), repolarizaciĆ³n temprana