What does the doctor see on film?
After the ventricles are excited, the heart cells restore their original electrical charge - this is repolarization. With early repolarization, the process in part of the myocardium begins a little earlier than usual, and on the ECG, a notch or step appears at the junction of the complex into the segment, and the segment rises. This pattern is often more pronounced when the heart rate is low and decreases with exercise—this is one of the reasons why a cardiologist prescribes an exercise test to clarify.
- Elevated point of transition of the complex into the ST segment
- A notch or step on the downward portion of a tooth
- Changes are more common in the inferior and lateral leads
- The picture intensifies with a low pulse
- Usually decreases with load
Who has it?
The finding is described in a significant proportion of healthy young people. It is more common in men, in people who regularly exercise, and in those who have an initially low pulse. The electrocardiographic features of the athletic heart generally differ from the picture in untrained people, and the doctor takes this into account when interpreting. The presence of such a picture in a healthy person without complaints is not a reason to limit physical activity or refuse permission to work.
- Young men
- Athletes and physically active people
- People with a low heart rate
- Sometimes it's a family trait
- Less common with age
How is it different from heart attack and pericarditis?
ST segment elevation is an alarming sign during myocardial infarction, so it is important not to confuse the picture of early repolarization with it. The clinical situation is of key importance: during a heart attack there is severe chest pain, changes increase in dynamics over minutes and hours, and markers of myocardial damage increase. With pericarditis, elevation is common in almost all leads, pain depends on body position and breathing. Early repolarization is stable for years and is not accompanied by complaints, and comparison with old films usually removes the issue.
- Heart attack: acute pain, increasing changes, rising troponin
- Pericarditis: pain related to breathing and body position
- Early repolarization: stable picture, no complaints
- Old ECGs for comparison help
- If in doubt - troponin and echocardiography
When is additional examination needed?
It is not the film itself that causes concern, but its combination with complaints and family history. If a person has had fainting for no apparent reason, especially during exercise or at night, or there has been a history of sudden death at a young age in the family, the cardiologist will conduct an extensive examination. The structure of the heart, circadian rhythm, response to stress are assessed and, if necessary, referred to an arrhythmologist. This approach allows us to identify rare cases when the pattern is associated with an increased risk of rhythm disturbances.
- Fainting without a clear reason
- Sudden death in relatives under 40–45 years of age
- Palpitations with poor tolerance
- ECG changes appeared for the first time in a person older than middle age
- Associated chest pain and shortness of breath
What should the patient do?
If there are no complaints, there was no fainting and the relatives are healthy, special treatment and restrictions are usually not required. It is useful to save the film and take it with you to future examinations: it is the comparison in dynamics that eliminates unnecessary hospitalizations for occasional chest pain. Medicines are not prescribed for asymptomatic early repolarization, and any drugs “for the heart” without indications can be harmful. General measures to prevent heart disease remain relevant for everyone.
- Save the ECG and show it when calling
- Routine examination by a cardiologist in case of complaints
- Do not take medications unless prescribed
- Control of blood pressure, cholesterol, weight
- Quitting smoking and energy drinks
- In case of fainting - mandatory examination
- Athletes - regular medical clearance
