Give me ecg changed and ecgs of top 10 most common cases

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ECG electrocardiogram STEMI ST elevation myocardial infarction

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ECG atrial fibrillation irregular rhythm

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ECG complete heart block third degree AV block

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ECG left bundle branch block LBBB wide QRS

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ECG hyperkalemia peaked T waves sine wave

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ECG ventricular tachycardia wide complex tachycardia

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ECG pulmonary embolism S1Q3T3 right heart strain

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ECG Wolff-Parkinson-White WPW delta wave pre-excitation

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ECG pericarditis diffuse ST elevation saddle shape PR depression

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ECG long QT syndrome QTc prolongation torsades de pointes

I now have all the ECGs needed. Here is the comprehensive guide:

Top 10 Most Common ECG Cases — Changes & Tracings

1. 🫀 STEMI (ST-Elevation Myocardial Infarction)

ECG Changes

Feature	Details
ST elevation	≥1 mm in ≥2 contiguous limb leads, or ≥2 mm in ≥2 contiguous precordial leads
Reciprocal ST depression	In opposite leads (e.g., inferior STEMI → ST depression in I, aVL)
Hyperacute T-waves	Tall, broad, symmetric — earliest sign
Pathological Q-waves	Develop later → indicate necrosis (>25% QRS height, >40 ms wide)
Tombstoning	Convex/domed ST morphology = high-risk

Localisation:

Anterior (V1–V4): LAD occlusion
Inferior (II, III, aVF): RCA or LCx
Lateral (I, aVL, V5–V6): LCx
aVR elevation + widespread depression: Left main / proximal LAD

ECG — Anterior STEMI (Tombstoning, V2–V5)

ECG — Anterolateral STEMI with reciprocal changes

Anterolateral STEMI with reciprocal inferior ST depression

ECG — Inferolateral STEMI (II, III, aVF, V5–V6 elevation)

Inferolateral STEMI with annotated ST elevation and reciprocal depression

2. 💓 Atrial Fibrillation (AF)

ECG Changes

Feature	Details
No P-waves	Replaced by chaotic fibrillatory (f) waves — best seen in V1
Irregularly irregular R-R intervals	Hallmark feature
Narrow QRS	Unless aberrant conduction (e.g., WPW or BBB)
Ventricular rate	Variable; rapid if uncontrolled (>100 bpm)
f-wave amplitude	Coarse AF (>1 mm) vs. fine AF

ECG — Classic AF (absent P-waves, irregular RR)

Classic atrial fibrillation with absent P-waves and irregular rhythm

3. 🔵 Complete (Third-Degree) AV Block

ECG Changes

Feature	Details
Complete AV dissociation	P-waves and QRS complexes march independently
Regular P-P intervals	Atrial rate > ventricular rate
Regular R-R intervals	Escape rhythm is regular
Narrow QRS	Junctional escape (~40–60 bpm)
Wide QRS	Ventricular escape (<40 bpm) — infra-Hisian block
P-waves "march through"	Appear before, within, and after QRS

ECG — Complete Heart Block (wide QRS ventricular escape, AV dissociation)

Complete third-degree AV block with AV dissociation and wide escape rhythm

ECG — Complete Heart Block (narrow QRS junctional escape)

Complete AV block with narrow junctional escape rhythm

4. 🟦 Left Bundle Branch Block (LBBB)

ECG Changes

Feature	Details
QRS duration	>120 ms
Lead I, aVL, V5–V6	Broad, notched "M-shaped" R-wave (William pattern)
Lead V1	Deep, wide QS or rS pattern
No septal Q-waves	In lateral leads (I, V5–V6)
ST/T discordance	T-waves opposite to QRS direction (normal for LBBB)
New LBBB	Treat as STEMI-equivalent until proven otherwise (Sgarbossa criteria)

ECG — Classic LBBB (M-shaped R in I/aVL, deep QS in V1)

Left bundle branch block with wide QRS, M-shaped R waves and discordant T-waves

5. ⚡ Ventricular Tachycardia (VT)

ECG Changes

Feature	Details
Rate	100–250 bpm, regular
Wide QRS	>120 ms, bizarre morphology
AV dissociation	P-waves independent of QRS = diagnostic of VT
Capture beats	Narrow QRS amid wide complexes = VT
Fusion beats	Intermediate morphology = VT
Concordance	All precordial leads positive (positive) or all negative (negative) = VT
Northwest axis	Extreme axis deviation (aVR positive) = VT

ECG — Monomorphic VT (wide complex tachycardia, positive precordial concordance)

Monomorphic ventricular tachycardia with wide QRS and positive concordance

6. 🫁 Pulmonary Embolism (PE)

ECG Changes

Feature	Details
Sinus tachycardia	Most common ECG finding in PE
S1Q3T3	S-wave in I, Q-wave in III, T-wave inversion in III
T-wave inversions V1–V4	Right heart strain pattern
Incomplete/complete RBBB	Due to RV pressure overload
Right axis deviation	RV dilation
P pulmonale	Tall peaked P in II (>2.5 mm)
AF	Can be precipitated by acute PE

ECG — PE with S1Q3T3 + sinus tachycardia (annotated)

PE ECG showing S1Q3T3 pattern with annotated S wave lead I, Q wave and T inversion lead III

ECG — PE with S1Q3T3, RBBB, and V1–V4 T-wave inversions

PE with S1Q3T3, incomplete RBBB and right ventricular strain

7. ⚗️ Hyperkalemia

ECG Changes (progressive with rising K⁺)

K⁺ Level	ECG Finding
5.5–6.5 mEq/L	Tall, peaked (tented) T-waves — narrow base, symmetric
6.5–7.0 mEq/L	Flattened/absent P-waves, prolonged PR
7.0–8.0 mEq/L	Wide QRS — intraventricular conduction delay
>8.0 mEq/L	Sine-wave pattern → VF/asystole

ECG — Hyperkalemia (peaked tented T-waves, QRS widening)

Hyperkalemia ECG with peaked tented T-waves and QRS widening

ECG — Early Hyperkalemia (classic peaked T-waves, K⁺ 7.3)

Early hyperkalemia ECG with classic peaked narrow T-waves in precordial leads

8. 🌩️ Wolff-Parkinson-White (WPW) Syndrome

ECG Changes

Feature	Details
Short PR interval	<120 ms (bypasses AV node delay)
Delta wave	Slurred upstroke at start of QRS
Wide QRS	>120 ms (fusion of normal + accessory conduction)
Secondary ST/T changes	Discordant — opposite to QRS
Pseudo-infarct Q-waves	Negative delta waves mimic Q-waves
Risk	AF with rapid conduction → VF (avoid AV nodal blockers!)

Pathway localisation from delta wave polarity:

Negative delta in II, III, aVF → posteroseptal pathway
Positive delta in V1 → left lateral pathway

ECG — WPW (short PR, delta wave, wide QRS with annotated accessory pathway)

WPW syndrome ECG with short PR interval, delta waves annotated with arrows

ECG — WPW (posteroseptal pathway, negative delta in II/III/aVF)

WPW ECG demonstrating posteroseptal accessory pathway with negative inferior delta waves

9. 🔴 Acute Pericarditis

ECG Changes (4 stages)

Stage	Timing	ECG Change
I	Hours–days	Diffuse concave ST elevation (all leads except aVR/V1); PR depression
II	Days	ST normalises; PR still depressed
III	Weeks	T-wave inversions develop (without Q-waves)
IV	Weeks–months	ECG normalises

Key distinguishing features from STEMI:

Diffuse ST elevation (not territory-specific)
Concave/saddle-shaped ST (vs. convex in STEMI)
PR depression in II, V4–V6 (PR elevation in aVR)
No reciprocal ST depression (except aVR and V1)
Spodick's sign — downsloping TP segment

ECG — Acute Pericarditis (diffuse saddle-shaped STE + PR depression)

Acute pericarditis ECG with diffuse concave ST elevation and PR segment depression

ECG — Pericarditis (diffuse STE, PR depression, Spodick's sign annotated)

Pericarditis ECG with Spodick sign and widespread ST elevation PR depression

10. ⏱️ Long QT Syndrome (LQTS) / Torsades de Pointes

ECG Changes

Feature	Details
QTc prolongation	Males: >440 ms; Females: >460 ms; Alarming: >500 ms
QTc formula	QT / √RR (Bazett); also use Fridericia
T-wave morphology by subtype	LQT1: broad-based T; LQT2: notched/bifid T; LQT3: late-onset T with long isoelectric ST
Torsades de Pointes	Polymorphic VT with QRS axis "twisting" around the baseline
Triggers	Hypokalemia, drugs (antiarrhythmics, antiemetics, antipsychotics), congenital mutations

ECG — Long QT Syndrome (QTc 514 ms, broad T-waves)

Long QT syndrome ECG with QTc 514ms and broad prominent T-waves in precordial leads

ECG — LQTS with Torsades de Pointes (twisting QRS morphology)

Long QT syndrome degenerating into Torsades de Pointes with twisting QRS

Quick Summary Table

#	Condition	Key ECG Finding
1	STEMI	ST elevation ≥1 mm in ≥2 leads, reciprocal depression, Q-waves
2	Atrial Fibrillation	Absent P-waves, irregularly irregular rhythm
3	Complete AV Block	AV dissociation, regular escape rhythm, P-waves march through QRS
4	LBBB	QRS >120 ms, M-shaped R in V5–V6, QS in V1, no lateral Q-waves
5	Ventricular Tachycardia	Wide complex tachycardia, AV dissociation, capture/fusion beats
6	Pulmonary Embolism	Sinus tach, S1Q3T3, T-wave inversions V1–V4, RBBB
7	Hyperkalemia	Peaked T-waves → wide QRS → sine wave
8	WPW Syndrome	Short PR, delta wave, wide QRS
9	Acute Pericarditis	Diffuse concave STE, PR depression, no reciprocal changes
10	Long QT / TdP	QTc >500 ms, broad/notched T-waves, polymorphic VT

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