CASE FOUR DIAGNOSIS

The rhythm is regular, rate is 43 times a minute, with normal PR, QRS, and QT intervals. What is obvious is the abnormality of the "ST Segments": they are elevated in Limb Leads I, II, III, AvF, and in the, chest leads V2-V6. They are elevated with a concave upward appearance, followed by peaked T waves.

When looking at an EKG, that shows ST Segment Elevation, there are several possible diagnosis:

Acute Pericarditis
Acute Myocardial Ischemia/Infarction
Early Repolarization (ERP)

The EKG shown here is a classic example of ERP, which can be a normal variant. ERP is found in approximately 1-2 % of the general population. It is a common finding in the healthy, physically fit young men, especially in African American. It is benign, a symptomatic, is not a marker for any type of heart disease and does not require treatment.

Classic Characteristics of ERP:
ST Segments originate from a high take off of the J Point (where the end of the QRS meets the baseline), and displays upward concavity.
ST Segment elevations is most prominent in the right precordial leads.
ST Segment elevation persists for long periods of time
Reciprocal ST Segment depression does not occur
There is notching on the downstroke of the R wave in several leads
Early precordial transition of QRS complexes, tall R & T waves are common findings

This patient was admitted for observation and was discharged, his symptoms were attributed to musculoskeletal.

CASE ONE
CASE TWO
CASE THREE