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To the Editor: In his Contempo Updates article about acute pericarditis, Dr Spodick¹ did not discuss early repolarization pattern of the electrocardiogram (ECG) as an item in the differential diagnosis. Early repolarization pattern is common among healthy men who may coincidently have musculoskeletal chest pain. Characteristic ECG patterns include J point and ST segment elevation with upward concavity and notching at terminal QRS complex.^2-3 In fact, the ECG presented by Spodick is indistinguishable from an early repolarization pattern except for the PR segment elevation in the aVR lead. The ECG should always be interpreted in the context of clinical symptoms.

Ishak Mansi, MD
Garden Medical Clinic
Garden City, Kan

1. Spodick DH. Acute pericarditis: current concept and practice. JAMA. 2003;289:1150-1153. FREE FULL TEXT 2. Mehta MC, Jain AC. Early repolarization on scalar electrocardiogram. Am J Med Sci. 1995;309:305-311. PUBMED 3. Simonson E. Differentiation between normal and abnormal in electrocardiography. St Louis, Mo: CV Mosby Co; 1961:45.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289:2942.

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