Navigating Diagnostic Difficulties: Benign Early Repolarization/Subtle ST Elevation in a Young Patient Presenting As Myocardial Infarction

In adults having chest pain, ST-segment elevation, both benign and pathologic, is a common finding seen on electrocardiograms (ECGs). Some degree of ST-segment elevation is common, especially in young men. Commonly referred to as benign early repolarization (BER), this elevation is seen in the precordial leads. Due to the prevalence of this finding, it is not a normal variant, but rather a normal finding. Here is an unusual case of acute myocardial infarction (MI) presenting as BER. In this case, the ECG did not show typical ST elevation or evolve over time, showing changes of Q waves as expected with ST-segment elevation myocardial infarction. However, the point-of-care troponin was elevated, and the patient was then diagnosed as having acute MI.