Normal variant ST elevation can occur in healthy, often young, patients. It is very important to differentiate it from acute ischemia. It has also been known as Benign Early Repolarisation.
Typical features of normal ST elevation include:
- Concave ST elevation, most often in the anterior leads
- J waves / J wave notching
- Absence of reciprocal ST depression
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This ECG is from a man in his 30s who presented with chest pain for a week on a background of anxiety, asthma and alcohol use disorder.
This ECG shows ST elevation in V2-6, with convexity. Serial ECGs showed no evolution and serial troponins did not rise. The 4-variable formula gives a false positive with this ECG due to the convexity.