The Diagnostic Dilemma of Early Repolarisation Pattern in a patient with Ischemic Chest Pain- a benign Culprit

Early Repolarisation Pattern (ERP) is an umbrella term that refers to ST-Segment elevation in the absence of chest pain, terminal QRS slurring, or terminal QRS notch. In patients with angina or anginal equivalents with ERP pattern on ECG(Electrocardiograph), the diagnostic dilemma of ERP masking ischemia vs. non-cardiac chest pain cause can falter further workup. We present a case of a 40-year-old male with risk factors of smoking and dyslipidemia presented with complaints of typical anginal chest pain. On primary evaluation he was found to have an Early repolarisation pattern in ECG, despite having a normal 2D Echo and negative cardiac biomarkers, His CAG revealed single vessel disease in the Left Circumflex coronaries. After revascularisation, the patient showed both angiographic and symptomatic improvement.