Page 178 - Clinical Pearls in Cardiology

166 Clinical Pearls in Cardiology

18. What are the features of early repolarization in the
ECG?
Early repolarization or J point elevation is a normal
variant that occurs commonly in young males, especially
blacks. J point or junction point is the place where the
ST segment ‘takes off’ from the end of the QRS complex.
Early repolarization is distinguished by the following
features:
• Concave upwards elevation of the ST segment (as
shown in Fig. 5)
• Notched J point producing a subtle ‘fishhook’
configuration in leads V3, V4.
• Well-demarcated and independent T waves (as
shown in Fig. 5)
• ST segment elevation limited to the precordial leads
(usually to V2, V3, V4)
• There may be reciprocal ST depression in lead aVR.
• ST segment returns to the baseline with exercise.

Fig. 5: Various ECG patterns of early repolarization