=====Early repolarisation=====
Benign Early Repolarisation (BER)
<WRAP notice round 70%> Interpretation of the ST segment is very much dependent on the clinical scenario:
  *upward ST concavity in asymptomatic patient may be benign early repolarisation
  *upward ST concavity in young patient with pleuritic chest pain may be pericarditis
  *upward ST concavity in older patient with chest pain may be MI

but beware!! see warning below...
</WRAP>
|:::| •common in young, less common >50yo and rare in >70yo  |
|{{:wiki:cardiovascular:ecg_conditions:st-segment-t-wave-ratio-ber.png?200|}}| •ST elevation <25% height of T wave  |
|{{:wiki:cardiovascular:ecg_conditions:t-wave-morphology-ber.jpeg?200|}}| •T wave is usually peaked and asymmetrical\\ •ST and ascending element of T wave form a smooth curve whereas descending T wave is usually steeper  |
|{{:wiki:cardiovascular:ecg_conditions:st-segment-t-wave-ratio-pericarditis.png?200|}}|**pericarditis vs BER**\\ •ST/T wave ratio is greater\\ •ST changes are more widespread vs primarily precordial\\ •PR depression vs none  |
<WRAP warning round 70%>There is some debate about the benign nature of Early Repolarisation.\\ There appears to be an increased incidence of sudden cardiac death especially in some </WRAP>
Early repolarization characteristics associated with SCD include:
  *high amplitude J-point elevation - especially >0.2mV
  *horizontal and/or downsloping ST segments
  *inferior and/or lateral leads location
{{:wiki:cardiovascular:ecg_conditions:ecg-fish-hook-pattern-ber.png?200|}}

====Subtle ant MI vs normal variant ST elevation====

Aslanger modification of 4 variable formula:\\ 
**(RAV4 + QRSV2) - [(QT in mm) + STE60V3); a value < 12 is indicative of LAD occlusion**
  *R amplitude in V4
  *QRS amplitude in V2
  *QT - in mm
  *STE60V3 - ST elevation in mm at 60ms point (1mm = 40ms)


----
**References include:**\\ 
https://litfl.com/benign-early-repolarisation-ecg-library/\\ 
[[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549780/|Early repolarisation syndrome - a cause of sudden death 2015]]\\ 
[[https://pubmed.ncbi.nlm.nih.gov/30107901/|Distinguishing between ant MI and normal variant ST elevation]]\\