Repolarization, Elevated ST...is further investigation warranted?

[davimed]

Does one ECG showing early repolarization and ST elevation with sinus bradycardia (55bpm in sedentary, unfit 45 y.o male), sinus arrhythmia, normal T wave inflection, together with a family history of heart attacks in males (unknown cause and type) warrant further investigation to differentiate benign early repolarization from other conditions? What are the other conditions? What tests should be done?

Symptoms:
General fatique
No chest pain, perhaps occasional discomfort (could be referred pain from back condition).
Cervical Radiculopathy (numb left arm on waking)
No blood tests done yet.
Distant history of renal stones, elevated calcium in urine, plasma levels unknown

Thanks

David

[CCF-M.D.-MJM]

Hi David,

This is a good (but difficult) question.  The truth is that this is often a judgment call based on your physician’s clinical suspicion that something could be wrong.  If the EKG is truly just early repolarization, then I would say no, the EKG alone does not merit further evaluation.  Coronary artery disease does not usually present as ST elevations without chest pain or other symptoms.  Rare syndromes like Brugada can present with syncope (passing out) and ST elevation in lead V1.  Hypertrophic cardiomyopathy can also present as ST elevations or ST depression, but this is usually associated with other abnormalities.

It would not be unreasonable to do a stress test prior to your initiation of an exercise program.  It is also reasonable to check your cholesterol.

I hope this answers your questions.  Good luck and

[davimed]

Thanks Dr,

While I don't expect a follow-up....
I got a copy of the ECG traces and put together more details if anyone's interested. Since I don't have a scanner I've used a shorthand that I think might be able to be followed if I've got my QRS's right.

Trying not to be alarmist but silent MI (STEMI) or impending MI a possibility? What's with S waves?

I   R5    S3
II  Q 1    R15    ST 1 elevated
III Q 1   R 13    ST 1 elevated slurred J  
V1 R 1    S 7 no T
V2 R 5    S 8  ST 1 elevated slow J point transition into T
V3 R 7    S 4   ST 2  elevated
V4 R 16    S 2    ST 2  elevated sharp transition at J
V5 tiny Q notch R 21 S1  ST 2  elevated sharp transition at J
V6 Q 1   R 21  ST 2  elevated sharp transition at J
aVR corresponding T attack concavity
aVL R 1 S 7 v small ST 1
aVF Q 1    R14   ST 1 elevated

Numbers are amplitudes in small squares
Any negative deflection is considered a Q even 1 small square

All 'ST' transitions early except aVF. Repolarization starts early on all T's except V1 where there's no T (doh?)

All T are asymetrical and peaky with concave attack and faster decay.

QRS duration appears a little broader on V1, V2 & V3

U waves on V2-V6

Sinus Arrhythmia 1, .88, .84, 1.04, 1.16, 1.16, 1.08, 1.08 (duration between 9 Rs over 10 sec)
Vent Rate 56
PR Interval 168
QRS Duration 88
QT/QTc 416/409
P-R-T axes 43 84 82

Machine said Borderline ECG

Thanks again

David