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Early Repolarization: Benign or Malignant?
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Early Repolarization: Benign or Malignant?

    I have a history of mild to moderate palpitations and flutters. I recently got some work up done and found out it's not structural. Furthermore, I have been to an electrophysiologist and after reviewing several of my past EKG's we have ruled out many electrical syndromes like LQT, CPVT, and Brugada. One thing I did notice is that one of my EKG's said that I showed early repolarization. I know that being a young athlete can sometimes make this a normal, benign variant, but I have also read that it could be associated with increased risk of sudden cardiac death. Given that fact that I do experience palpitations sometimes I guess I was just wondering if anyone could help clear a few things up for me....
1.) First of all I heard that the morphology of the ST segment (whether it is ascending, descending, or horizontal) often determines if early repolarization is benign or dangerous. I heard that having ascending ST segments is of the benign variety. Is this true?
2.) Also, I had heard that it is worse to have early repolarization in the inferior leads (II, III, and AVF). Is this true?
3.) Is it possible to have early repolarization in a given lead if there is no ST segment elevation (amplitude below 1mm)? I ask because it does appear that my ST segment in leads III and AVF is descending, but it also appears that there is no ST elevation in these leads as the J point is pretty much parallel to the PR segment on the other side of the QRS complexes. So, does this mean there is not early repolarization in those leads, making it meaningless what the morphology of the ST segments in those leads are?
4.) I have taken many EKG's for various reasons throughout the years (sports physicals, panic attacks, dehydration, and most recently the EKGs during this investigation of my life long palpitations) and none of them have ever said anything about early repolarization or ST elevation aside from this one. Since this particular EKG was taken after my near fainting dehydration episode after a long run in the heat last summer, I am wondering if having gone through a major vagus nerve enhancing event (the near fainting from heat) could have provoked early repolarization that is not normally present to show up. Would this be something that could happen?
5.) Finally, today my EP had me take a stress test yesterday. Before I left I noticed on the print outs of the post test EKG showed ST segment elevations of 1.8mm in a couple of the inferior leads, but the right precordial leads (V1-V3) were not showing elevation (they were like 0.2mm). Is this bad? I know that sometimes ST segment elevation can rise after cooling down from exercise in cases of malignant early repolarization, so I don't know if this happening in the inferior leads would be considered a very bad sign or not?
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