This is the ECG of a 58 year old man who is being assessed in the anaesthesia clinic prior to a prostatectomy. ST elevation has been noted. The patient has no history of chest pain or dyspnea. His exercise tolerance is good:

• Sinus rhythm
• Early repolarization ( normal variant)

There is ST elevation with upward concavity in the chest leads and not in the limb leads. The T waves are tall (the ratio of the voltage of the T wave to the voltage of the ST elevation is >4:1). These findings are in keeping with “early repolarization”, a normal variant, and help to distinguish it from pericarditis. Early repolarization is more frequently seen in young men.

Link to reference article: Ginzton LE, Laks Michael, The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Circulation 65:1004,1982  http://circ.ahajournals.org/cgi/reprint/65/5/1004