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Answer for February 25, 2013

This EKG with the clinical presentation is most consistent with the diagnosis of "Early Repolarization/Normal variant".  Early repolarization is actually a misnomer, since repolarization is not 'early'. The pattern is one of localized or diffuse ST segment elevation, especially in leads with prominent R waves. Symmetric, large, upright Twaves and a concave upward ST segment are also characteristic. In contrast pericarditis (with which this could easily be confused) usually has lower amplitude Twaves, and possibly PR segment depression.

However, clinical context is the major differentiator here. This patient is healthy, and does not require further investigation. However, it is easy to see that false positives can bedevil EKG screening of young people. For this and other reasons, the ACC and sports medicine authorities in the US do not generally recommend EKG pre-screening of athletes.

NOTE: EKG's are for internal educational purposes of the University of Massachusetts Department of Family Medicine. Please do not forward without permission from Dr. Golding!

February 25 EKG