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Based on this EKG alone it is hard to tell but if I had to guess I would place my bet on early repolarization. Here's why:
- There is no PR segment deviation (relative to the TP segment), neither PR elevation in aVR nor PR depression in the other leads.
- Compared to an old EKG (not shown) there are no evolving changes. Pericarditis causes a typical progression of EKG changes from onset of disease to resolution.
- The ratio of ST elevation to T wave amplitude in V6 is less than 0.24. If it is greater, than pericarditis is present.
- Finally, the ST elevations are primarily located in the precordial leads. Pericarditis generally causes diffuse ST elevations in BOTH limb and precordial leads whereas about half of patients with early repolarization have no ST deviations in the limb leads.
Imazio, M. "Clinical presentation and diagnostic evaluation of acute pericarditis" Up to Date. Jan 2012.