A 25-year-old man presents for a routine employment physical and is completely asymptomatic. His 12-lead ECG shows 1-2 mm concave ST-segment elevation in leads V2-V5 with a small notch at the J point. There are no reciprocal ST depressions, and his vital signs and physical examination are normal. Which of the following is the most likely explanation for the ST-segment elevation in this patient?
Benign (early) repolarization is a common normal variant seen in young, healthy adults. It typically produces mild, diffuse, concave ST-segment elevation-often most pronounced in the mid-to-left precordial leads-and may show a notched or slurred J point. The absence of symptoms, reciprocal changes, or other signs of ischemia makes early repolarization the most likely diagnosis, whereas conditions such as pericarditis, hyperkalemia, or acute STEMI would be expected to produce additional clinical or ECG findings.
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Cardiovascular Emergencies
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