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Early repolarization: Safety Profile

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SMSRAZA

Benign or Lethal?

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EARLY REPOLARIZATION: CONCEPT IN THE CURRENT ERA Dr SYED RAZA Consultant Cardiologist MD,MRCP(UK),Dip.Card(UK),CCT(UK),FCCP(USA )
 
IMPORTANCE OF CLINICAL CORRELATION ,[object Object],[object Object],[object Object]
 
 
 
 
 
 
Classic findings ,[object Object],[object Object],[object Object],[object Object]
Early Repolarization ,[object Object],[object Object],[object Object]
What is it? ,[object Object],[object Object],[object Object],[object Object]
PREVALANCE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What does it look like? Red arrows : concave up ST-segment elevation anteriorly Blue arrows : hyperdynamic, symmetrical, concordant T-waves
Can we tease it out? ,[object Object],[object Object],[object Object]
24yo M Routine ECG HR: 64
[object Object],[object Object]
Same patient after exercise (2 minutes of Jumping Jack) HR 84 (up 20bpm from previous)
HR 64 HR 84 The ST segment is NOT fixed in pts with ER and changes with the degree of sympathetic strain On the right, note the complete resolution of the ST elevation but maintenance of the J-point notching in V4
(…but is it really benign?) Benign early repolarization
 
 
 
 
 
ER not benign : Where is the evidence? ,[object Object],[object Object],[object Object]
Study by Haissaguerre et al. ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
 
Tikkanen et al, NEJM Dec. 2009 (Finnish Pop. 10,000. FU 30 YRS) ,[object Object],[object Object]
Inferior vs Lateral leads ,[object Object]
Does Amplitude matter? ,[object Object]
Mechanism ,[object Object]
HYPOTHESIS ,[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object],[object Object]
SUMMARY ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 

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Early repolarization: Safety Profile

  • 1. EARLY REPOLARIZATION: CONCEPT IN THE CURRENT ERA Dr SYED RAZA Consultant Cardiologist MD,MRCP(UK),Dip.Card(UK),CCT(UK),FCCP(USA )
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  • 14. What does it look like? Red arrows : concave up ST-segment elevation anteriorly Blue arrows : hyperdynamic, symmetrical, concordant T-waves
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  • 16. 24yo M Routine ECG HR: 64
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  • 18. Same patient after exercise (2 minutes of Jumping Jack) HR 84 (up 20bpm from previous)
  • 19. HR 64 HR 84 The ST segment is NOT fixed in pts with ER and changes with the degree of sympathetic strain On the right, note the complete resolution of the ST elevation but maintenance of the J-point notching in V4
  • 20. (…but is it really benign?) Benign early repolarization
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