Scenario: This electrocardiogram (ECG) strip was recorded for a 22-year-old, white, male firefighter during a live-burn training at a county fire academy. This young man has no significant medical history, does not take any prescriptions, and is deemed otherwise healthy. He is muscular, physically fit, and his body mass index is 26 kg/m2. Due to the well-known relationship between exertional thermal stress and cardiovascular mortality, firefighters are recommended to undergo thorough assessments before they are cleared for duty. Does this ECG strip warrant any further cardiac workup?

This ECG rhythm is most consistent with early repolarization syndrome (ERS).

ERS was recognized nearly a century ago and was believed to be a benign normal variant that is especially prevalent in young, athletic men. This pattern occurs in approximately 6% of the general population, and in 30% to 44% of athletes. In the past, ERS...

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