Scenario: This is a resting 12-lead ECG obtained in a 47-year-old African American male patient presenting to the emergency department with complaints of atypical chest pain. The patient has no prior history of heart disease but is a smoker and has a sedentary lifestyle.

Interpretation: Sinus rhythm, left ventricular hypertrophy (LVH), and ST-segment elevation in the precordial leads due to early repolarization syndrome (ERS).

Although the prevalence of ERS is low (1% to 2%), it is not uncommon to see this ECG pattern in patients presenting to acute care facilities with symptoms suggestive of acute myocardial infarction (MI). ERS is considered to be an idiopathic yet benign ECG pattern. One feature of ERS is ST-segment elevation; hence, it is possible to interpret this ECG pattern as an acute MI. It is important to distinguish these 2 ECG patterns to...

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