This 33-year-old man had been referred because of recurrent episodes of sharp localized pain in his left lower anterior chest, lasting from a few seconds to one minute:

• Sinus rhythm, 61/min
• ST elevation compatible with early repolarization (a normal variant)
• In favour of the diagnosis of early repolarization over acute pericarditis: Elevation of the J point, with a small notch/wave; concave ST elevation, more prominent in the chest leads; T/ST voltage ratio of 4:1 or greater

The patient had become very anxious and stopped exercising, despite his family doctor’s reassurance. He underwent an exercise echocardiogram, during which he reached target without chest pain or undue dyspnea. The test was normal, and the patient returned to his normal very active life without further symptoms.