The influence of early repolarization variant on the exercise electrocardiogram: a correlation with coronary...

Sixteen adult patients with S-T segment elevation in their resting electrocardiograms characteristic of early repolarization variant (ERV) and chest pain syndromes of possible myocardial ischemia were evaluated with both treadmill exercise electrocardiography and coronary arteriography. Of 14 patients with normal coronary arteriograms, 13 had their resting S-T elevation return ("normalize") to the isoelectric baseline with physical exercise, while one patient with normal arteriograms and normal left ventricular contractility but moderately elevated left ventricular end-diastolic pressure of unknown etiology developed significant S-T depression with exercise. Two patients with significant coronary atherosclerotic occlusive lesions developed "ischemic" S-T depression during treadmill testing. Symptoms developed during treadmill exercise did not distinguish patients with coronary artery disease from those without. Thus, while ERV at rest may be "normalized" by graded physical exercise in the absence of significant coronary atherosclerosis, the presence of ERV does not prevent the usual electrocardiographic manifestations of exercise-induced myocardial ischemia.