Benign Early Repolarisation

- AKA: “J-point elevation”, “high take-off”

Benign early repolarisation (BER) is a ECG pattern most commonly seen in young, healthy patients < 50 years of age. It produces widespread ST segment elevation that may mimic pericarditis or acute MI

- Up to 10-15% of ED patients presenting with chest pain will have BER on their ECG, making it a common diagnostic challenge for clinicians

- BER is less common in the over 50s, in whom ST elevation is more likely to represent myocardial ischaemia

- It is rare in the over 70s

- Widespread concave ST elevation, most prominent in V2-5

- Notching or slurring at the J-point

- Prominent, slightly asymmetrical T-waves that are concordant with the QRS complexes (pointing in the same direction).

- The degree of ST elevation is < 25% of the T wave height in V6)

- ST elevation is usually < 2mm in the precordial leads and < 0.5mm in the limb leads, (although precordial STE may be up to 5mm in some instances)

- No reciprocal ST depression to suggest STEMI (except in aVR)

- ST changes are relatively stable over time (no progression on serial ECG tracings)

One characteristic feature of BER is the presence of a notched or irregular J
point (“fish hook” pattern)
This is often best seen in lead V4

- The vertical height of the ST segment elevation (from the end of the PR segment to
the J point) is measured and compared to the amplitude of the T wave in V6.

- A ratio of > 0.25 suggests pericarditis

- A ratio of < 0.25 suggests BER