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December 1, 2014 by dailybolusoflr
By Anneliese Cuttle, MD
Benign Early Repolarization, or “J-point elevation”
- J-point is where the QRS complex meets the ST segment
- Benign early repolarization (BER) frequently seen in young, healthy patients, is characterized by J-point elevation with a characteristic, concave-up morphology
- BER can be difficult to distinguish from STEMI or pericarditis
- Estimated to be present in 10-15% of ED patients with chest pain
- Less common in those older than 50, rare in those over 70
EKG features of BER
- Widespread concave up (think smiley face) ST segment elevation, most prominent in V2-V5
- Notching or slurring of J-point
- Degree of elevation may vary with heart rate, typically being more noticeable at slower rates
- May gradually disappear over time
BER vs. Pericarditis
- Pericarditis has diffuse ST elevation, whereas BER tends to be limited to precordial leads
- Pericarditis- look for PR depression in multiple leads
- Look at the V6- if the height of the ST segment elevation is more than 1/4 of the height of the T wave, this suggests pericarditis. If it is less than 1/4 of the height it is more suggestive of BER.
- V4- often has a “fishhook” (notched) appearance in BER, absent in pericarditis
BER vs. STEMI
- In reality, you have to consider the clinical picture and use all the information available. For example, if you have something that looks like BER, but the history is concerning, repeat the EKG in 5 minutes, then in another 5. Repeat it after a nitro. If the ST segments or T waves are changing, and the story fits, have a low threshold to call the PCI attending.
- Chan TC, Brady WJ, Harrigan RA, Ornato JP and Rosen PR. ECG in Emergency Medicine and Acute Care. Elsevier 2005
- Mattu A, Brady W. ECGs for the Emergency Physician 2, BMJ Books 2008.