'Early repolarisation' (ER) represents a normal electrocardiographic variant with persistent ST segment elevation and is considered a benign condition. ER is found in approximately 1% of the population and in up to 13% of patients presenting with chest pain in the emergency room. This case report presents a 49 year-old man with ER suspected of acute myocardial infarction due to the combination of chest pain and electrocardiographic ST segment elevation. [figure: see text] The case report describes the electrocardiographic characteristics associated with the syndrome ER and the problems in distinguishing ER from other ST segment elevation syndromes.