Unraveling Early Repolarization: Recognizing Symptoms and Their Implications

Author(s): Mehek Ghosh

Early Repolarization Syndrome (ERS) is an electrocardiographic finding characterized by specific patterns on the surface electrocardiogram (ECG). It is commonly observed in asymptomatic individuals but can also be associated with adverse cardiac events such as ventricular fibrillation and sudden cardiac death. This abstract aims to summarize the symptoms and clinical presentations associated with early repolarization, highlighting the importance of recognizing this condition for appropriate risk stratification and management.ERS is characterized by J-point elevation and ST-segment elevation on the ECG, typically seen in the inferior and/or lateral leads. Although frequently observed in healthy individuals, it can also manifest in patients with a history of cardiac symptoms, palpitations, or syncope. Furthermore, the ECG findings of early repolarization may be incidentally detected during routine health check-ups or investigations for unrelated complaints. Symptoms associated with ERS can vary widely, ranging from no symptoms at all to severe cardiac events. The most common presenting symptom in individuals with early repolarization is chest pain or discomfort. This pain is usually described as non-exceptional, transient, and unrelated to physical activity. Palpitations, dizziness, and syncope can also occur, especially in individuals with significant J-point elevation and dynamic ST-segment changes. It is crucial to differentiate between benign early repolarization patterns and those associated with an increased risk of arrhythmias and adverse cardiac events. The presence of certain ECG features such as excessive J-point elevation, horizontal or downsloping ST-segment, and QRS slurring (known as “fishhook pattern”) can help identify individuals at higher risk. Additionally, certain high-risk factors such as a family history of sudden cardiac death, prior arrhythmias, or unexplained syncope may warrant further evaluation and consideration for specialized testing or referral to a cardiologist.In early repolarization syndrome is a common ECG finding that may or may not be associated with symptoms. Recognition of symptoms associated with early repolarization is essential for appropriate risk stratification and management. While the majority of individuals with early repolarization have a benign course, identification of high-risk features and consideration of individual risk factors are crucial to prevent potential life-threatening cardiac events. Further research is needed to better understand the underlying mechanisms and establish evidence-based management strategies for individuals with early repolarization syndrome