An 18 year old with chest pain and diffuse ST Elevation

An 18 year old complained of chest pain.Here is his ECG:  What do you think?Comment on ECGMany immediately think this is pericarditis.  But, in fact, this is the patient ' s baseline early repolarization, seen on a previous ECGs when he presented for a seizure (not chest pain). Most diffuse ST elevation is normal variant.  --There isdiffuse ST Elevation.  --There are well-formednotchesat the J-point in all leads with ST Elevation.  The STE is called normal variant.  The notching qualifies the ECG as true early repolarization (which is now defined as distinct from normal variant STE and does not even require any STE -- see reference below).  Whether such notches also exists in pericarditis is uncertain; I suspect they exist in patients who have pericarditis superimposed on .  We studied it in anterior MI vs. normal variant STE in V2-V4, and found that at least 1 notch of at least 0.5 mm in at least 1 of leads V2-V6 was found in 31% of normal variant and 14% of anterior MI.--Theonly reciprocal ST depression is in aVR, but this is not significant (whenever there is diffuse STE, there MUST be STD in aVR since aVR is the (-) of a lead that would be between I and II.  Other than aVR,we found that reciprocal ST depression is not found in pericarditis. --There isminimal PR depression, though even some PR depression is normal; profound PR depression of at least 0.8 mm is reported as fairly specific to pericardi...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs