Benign Early Repolarization

Question 1

Who should you be hesitant to diagnose in based on demographics?

Answer 1

Anyone over the age of 50

BER is for young and healthy people

Question 2

What are the classic features of BER?

Answer 2

Diffuse ST elevations, most prominent in V4-6
Concave ST segments
Notching of the J-point, often more noticeable in the precordial leads
No reciprocal changes
Prominent T waves, usually asymmetric

Question 3

How can BER be distinguished from pericarditis?

Answer 3

Pericarditis has PR depression, larger ST elevation: T-wave amplitude ratio in V6 and less prominent T-waves throughout, and more prominent ST elevations throughout all leads whereas BER tends to be more pronounced in the precordial leads

Question 4

What is unique about the ST segment in relation to the T wave in BER in lead V6?

Answer 4

The ratio of ST-elevation to T wave amplitude should be less than 0.25 and will be larger than this in pericarditis

Question 5

How can BER be differentiated from anterior MI?

Answer 5

Ber should not have reciprocal ST changes, septal Q-waves, or an abnormal R wave progression whereas these features are commonly seen with MI

Question 6

How are T waves unique in BER?

Answer 6

Prominent, peaked, asymmetrical with gradual concave upslope and steep downslope