Electrocardiographic responses to maximal exercise during acute pericarditis and early repolarization

Area of Science:

• Cardiology
• Exercise Physiology
• Electrocardiography

Background:

• Exercise testing is typically contraindicated in active pericarditis due to potential myocarditis.
• Distinguishing pericarditis from other conditions like early repolarization on electrocardiograms (ECGs) during exercise is clinically important.

Observation:

• A patient with suspected ischemic heart disease developed a pericardial rub post-exercise.
• During maximal exercise, this patient's elevated J-points normalized.
• Two healthy volunteers with early repolarization showed similar J-point behavior during maximal exercise tests.

Findings:

• Electrocardiographic (ECG) responses during maximal exercise tests are not sufficient to differentiate between pericarditis and early repolarization.
• The normalization of elevated J-points during exercise in a patient with pericarditis mimicked the response seen in healthy individuals with early repolarization.

Implications:

• Clinicians should be aware that ECG exercise test findings may not reliably exclude pericarditis.
• Rethinking the diagnostic utility of ECG exercise responses in differentiating pericarditis from early repolarization is necessary.
• Further research may be needed to identify reliable markers for distinguishing these conditions during exercise stress tests.