Key result
Early repolarization morphology mimics acute pericarditis, demonstrating the clinical challenge of electrocardiographic overlap.
Why the study?
The ECG morphologies of early repolarization, acute pericarditis, and acute myocardial infarction are often similar and difficult to differentiate, potentially leading to unnecessary evaluation and treatment.
Case Report (n=1)
Early repolarization morphology on ECG can mimic acute pericarditis, emphasizing the need for careful ECG analysis (e.g., ST-segment to T-wave height ratio) to avoid unnecessary treatments.
Answers are grounded in this paper and cite their sources.
Case report underscores ECG mimicry caution in suspected pericarditis; leaves open systematic validation of diagnostic ratios.
A 27-year-old male presented to the outpatient clinic with a two-week history of daily episodes of palpitations, chest pain, and shortness of breath. He also complained of fatigue and nausea that continued after he recovered from an upper respiratory infection (URI) one month prior. Of note, he described the chest pain as increasing in intensity when sitting or standing upright. Auscultation revealed regular rate and rhythm with no audible rubs or murmurs. An electrocardiogram (ECG) was performed and showed diffuse ST-segment elevations that the machine interpreted as pericarditis. Based on the patient's symptoms and ECG findings, he was sent for an evaluation by cardiology. After he failed a trial of non-steroidal anti-inflammatory drugs (NSAIDs), the patient was started on colchicine and his symptoms ultimately resolved within a few weeks. Review of his records showed an ECG performed in the emergency department (ED) a year prior demonstrated morphology consistent with early repolarization (ER). The ECG morphology of ER, acute pericarditis (AP), and even acute myocardial infarction (AMI) can often be similar and difficult to differentiate. In this patient, confusing ER with AP may have led to unnecessary evaluation and treatment by a specialist.
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Rogers et al. (2019) conducted a case report in Early repolarization mimicking acute pericarditis (n=1). Colchicine was evaluated on Symptom resolution. A 27-year-old male with early repolarization morphology was misdiagnosed with acute pericarditis, demonstrating the clinical challenge of electrocardiographic mimicry between the two conditions.
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