Ecg related all diseases
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Here is a comprehensive overview of all major diseases and conditions diagnosed or characterized by ECG findings:
ECG-Related Diseases and Conditions
The ECG is one of the most powerful diagnostic tools in medicine. Below is a systematic classification of all major diseases identifiable on ECG.
1. Ischemic Heart Disease
ST-Elevation Myocardial Infarction (STEMI)
The ECG is diagnostic for STEMI. Classic sequence of changes:
| Phase | ECG Change |
|---|---|
| Hyperacute (minutes) | Peaked, tall "hyperacute" T waves |
| Early (hours) | ST elevation in contiguous leads |
| Established | Pathologic Q waves develop |
| Evolving | T-wave inversion |
ST elevation thresholds (Washington Manual):
- Men >40 years: ≥2 mm in V2-V3, >1 mm in all other leads
- Men <40 years: >2.5 mm in V2-V3
- Women: >1.5 mm in V1-V3, >1 mm elsewhere
Anatomic localization:
| ST Elevation Leads | Territory | Artery |
|---|---|---|
| V1-V6 or new LBBB | Anterior/septal | Proximal LAD or left main |
| V1-V2 | Septum | LAD septal branch |
| V2-V4 | Anterior wall | LAD |
| V5-V6 | Lateral wall | LCX |
| II, III, aVF | Inferior | RCA or LCX |
| I, aVL | High lateral | Diagonal or proximal LCX |
| V7-V9 (posterior leads) | Posterior | LCX |
NSTEMI / Unstable Angina (NSTE-ACS)
- ST depression (especially in V1-V4), T-wave inversions
- No new Q waves
- Diagnosis is combination of history, ECG, and troponin
Right Ventricular Infarction
- Occurs with proximal RCA occlusion (inferior STEMI)
- Right-sided leads (V3R, V4R): ST elevation ≥0.5 mm (≥1 mm in males <30 years)
Posterior MI
- ST depression in V1-V3 + tall R waves in V1-V2 + R/S ratio ≥1
- Use posterior leads (V7-V9): ST elevation ≥0.5 mm diagnostic
2. Arrhythmias
Supraventricular Arrhythmias
| Condition | ECG Finding |
|---|---|
| Sinus tachycardia | Normal P waves, rate >100 bpm |
| Sinus bradycardia | Normal P waves, rate <60 bpm |
| Atrial fibrillation (AF) | Irregularly irregular, no P waves, fibrillatory baseline |
| Atrial flutter (AFL) | Sawtooth flutter waves at ~300 bpm; 2:1 block gives rate ~150 bpm |
| AVNRT | Narrow QRS tachycardia, P buried in or just after QRS |
| AVRT (WPW) | Narrow or wide QRS tachycardia; baseline shows delta wave + short PR |
| Junctional tachycardia | Narrow QRS, retrograde P waves |
| MAT | ≥3 distinct P-wave morphologies, irregular rate |
Ventricular Arrhythmias
| Condition | ECG Finding |
|---|---|
| PVCs | Wide bizarre QRS, no preceding P, compensatory pause |
| Non-sustained VT (NSVT) | ≥3 consecutive wide QRS beats, <30 sec |
| Sustained VT | Wide QRS tachycardia ≥30 sec; AV dissociation |
| Torsades de Pointes | Polymorphic VT, twisting QRS axis; associated with long QT |
| Ventricular fibrillation | Chaotic, no discernible complexes |
3. Conduction Abnormalities / Heart Blocks
| Condition | ECG Finding |
|---|---|
| 1st degree AV block | PR interval >200 ms (0.20 sec), all P waves conduct |
| 2nd degree AV block - Mobitz I (Wenckebach) | Progressive PR prolongation until a P wave drops |
| 2nd degree AV block - Mobitz II | Fixed PR with sudden dropped beats; more serious |
| 3rd degree (complete) AV block | AV dissociation, P and QRS completely independent |
| Right Bundle Branch Block (RBBB) | RSR' ("M" pattern) in V1, wide S in V5-V6, QRS ≥0.12 sec |
| Left Bundle Branch Block (LBBB) | Broad notched R in I, aVL, V5-V6; QS in V1; QRS ≥0.12 sec |
| Left Anterior Fascicular Block | Left axis deviation, small Q in I/aVL, small R in II/III/aVF |
| Left Posterior Fascicular Block | Right axis deviation |
| Bifascicular block | RBBB + left fascicular block |
| Trifascicular block | Bifascicular + 1st degree AV block |
| Sinoatrial block | Pauses that are multiples of baseline PP interval |
| Sick Sinus Syndrome | Sinus bradycardia, pauses, tachycardia-bradycardia alternation |
4. Inherited Channelopathies / Genetic Arrhythmia Syndromes
(Harrison's Principles, Fuster & Hurst's The Heart, Tintinalli's Emergency Medicine)
| Syndrome | ECG Hallmark |
|---|---|
| Long QT Syndrome (LQTS) | QTc >450 ms (men), >470 ms (women); risk of Torsades |
| Short QT Syndrome (SQTS) | QTc <330-360 ms; risk of VF and sudden death |
| Brugada Syndrome | Type 1: coved ST elevation ≥2 mm in V1-V2 with RBBB pattern; J-point elevation |
| Wolff-Parkinson-White (WPW) | Short PR (<0.12 sec), delta wave (slurred QRS upstroke), wide QRS |
| Catecholaminergic Polymorphic VT (CPVT) | Normal baseline ECG; bidirectional VT on exercise/stress |
| Early Repolarization Syndrome (ERS) | J-point elevation, notching/slurring of terminal QRS in inferior-lateral leads |
| Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) | Epsilon wave in V1-V2, deep S-wave upstroke, T-wave inversion in V1-V3; right bundle branch pattern |
5. Cardiomyopathies
| Condition | ECG Findings |
|---|---|
| Dilated Cardiomyopathy (DCM) | Left bundle branch block, LVH, non-specific ST-T changes, atrial fibrillation, PVCs |
| Hypertrophic Cardiomyopathy (HCM) | LVH voltage criteria, deep septal Q waves (pseudoinfarction pattern), apical T-wave inversion |
| Restrictive Cardiomyopathy | Low voltage, pseudo-infarct pattern (amyloid), AF |
| ARVC | Epsilon wave, T-wave inversions V1-V3 (detailed above) |
6. Pericardial and Myocardial Inflammation
Acute Pericarditis
Classic ECG stages (Goldman-Cecil Medicine, Braunwald's Heart Disease):
- Stage 1: Diffuse saddle-shaped ST elevation (concave up) + PR depression in most leads; PR elevation in aVR
- Stage 2: ST normalizes, T waves flatten
- Stage 3: Diffuse T-wave inversions (widespread)
- Stage 4: Normalization
Key distinguishing feature from STEMI: diffuse (not focal) ST elevation, PR depression, no Q waves, no reciprocal ST depression.
Myocarditis
ECG may show (Fuster & Hurst, Braunwald's):
- AV block (I-III degree)
- Bundle branch block
- ST-segment changes
- Non-specific T-wave changes
- Atrial and ventricular arrhythmias
- Rarely, pseudo-STEMI pattern
7. Structural / Valvular Heart Disease
| Condition | ECG Finding |
|---|---|
| Left Ventricular Hypertrophy (LVH) | Increased QRS voltage (Sokolow-Lyon: S in V1 + R in V5/V6 ≥35 mm); LV strain pattern (ST depression + T inversion in I, aVL, V4-V6) |
| Right Ventricular Hypertrophy (RVH) | Right axis deviation, tall R in V1, deep S in V5-V6, RV strain (T inversion V1-V4) |
| Left Atrial Enlargement | Bifid P (P mitrale) in II; biphasic P in V1 with broad negative terminal component |
| Right Atrial Enlargement | Peaked P wave (P pulmonale) ≥2.5 mm in II, III, aVF |
| Aortic Stenosis | LVH pattern |
| Mitral Stenosis | Left atrial enlargement, AF commonly |
8. Pulmonary Disease
| Condition | ECG Finding |
|---|---|
| Pulmonary Embolism (PE) | Sinus tachycardia (most common); S1Q3T3 pattern (S wave in I, Q wave + T inversion in III); new RBBB; right axis deviation; T inversions V1-V4; AF |
| Pulmonary Hypertension (PH) | RVH pattern, right axis deviation, P pulmonale, RBBB, RV strain |
| COPD/Cor Pulmonale | P pulmonale, RVH, right axis deviation, low voltage limb leads, clockwise rotation |
| Pneumothorax | Decreased voltage on affected side; right axis shift; sinus tachycardia |
9. Electrolyte Disturbances
| Electrolyte | ECG Finding |
|---|---|
| Hyperkalemia | Peaked T waves (early) → flat P waves → wide QRS → sine wave → VF/asystole |
| Hypokalemia | Flat/inverted T waves, prominent U waves, ST depression, prolonged QU interval, VT/VF risk |
| Hypercalcemia | Short QT interval, shortened ST segment |
| Hypocalcemia | Prolonged QT interval (long ST segment) |
| Hypomagnesemia | Prolonged QT, U waves, risk of Torsades |
| Hypermagnesemia | Prolonged PR, wide QRS, bradycardia |
10. Metabolic and Systemic Conditions
| Condition | ECG Finding |
|---|---|
| Hypothyroidism | Sinus bradycardia, low voltage, flat/inverted T waves, prolonged QT |
| Hyperthyroidism | Sinus tachycardia, AF, short PR |
| Hypothermia | Osborn (J) waves, prolonged all intervals, slow AF/VF |
| Digoxin toxicity | "Reverse tick" ST depression (scooped), short QT, bradyarrhythmias, AV blocks, PAT with block, bidirectional VT |
| Digoxin effect (therapeutic) | Scooped ST depression, T-wave changes; not necessarily toxic |
| Acute adrenal insufficiency | Low voltage, prolonged QT, T inversions |
11. Neurological and Miscellaneous Conditions
| Condition | ECG Finding |
|---|---|
| Subarachnoid hemorrhage / Intracranial catastrophe | Deep, diffuse T-wave inversions ("cerebral T waves"), QT prolongation, U waves |
| Cardiac contusion (trauma) | Arrhythmias, heart block, RBBB, non-specific ST-T changes |
| Cardiac tamponade | Sinus tachycardia, low voltage, electrical alternans (alternating QRS axis/amplitude) |
| Cardiac tumors / metastases | AV block, bundle branch block, non-specific ST changes |
| Tricyclic antidepressant (TCA) toxicity | Prolonged QRS (>100 ms), right axis deviation of terminal 40 ms, prolonged QT, sinus tachycardia |
| Antipsychotic toxicity | QTc prolongation |
| Cocaine use | Vasospasm pattern, STEMI-like ST elevation, accelerated heart rate |
12. Pre-excitation / Accessory Pathway Conditions
| Syndrome | ECG |
|---|---|
| WPW (overt) | Short PR, delta wave, wide QRS; risk of AF with rapid ventricular response |
| Lown-Ganong-Levine (LGL) | Short PR, normal QRS, no delta wave |
| Mahaim fibers | Normal PR, delta wave-like morphology, LBBB-like wide QRS |
13. Normal Variants That Mimic Disease
| Pattern | Meaning |
|---|---|
| Early repolarization | J-point elevation in inferior-lateral leads; mostly benign but can overlap ERS |
| Juvenile T-wave pattern | T inversion V1-V3 in young individuals |
| High vagal tone | Sinus bradycardia, 1st degree AV block, early repolarization in athletes |
| Isolated Q in III or V1 | Normal; not a sign of MI |
Quick Reference: ECG Findings and Their Differential Diagnosis
| ECG Finding | Key Differentials |
|---|---|
| ST elevation | STEMI, pericarditis, Brugada, early repolarization, LVH with strain, vasospasm, myocarditis, LV aneurysm, hyperkalemia |
| ST depression | NSTEMI/UA, posterior STEMI (V1-V3), LVH strain, digoxin effect, PE |
| T-wave inversion | Ischemia, ARVC (V1-V3), PE (V1-V4), HCM, myocarditis, cerebral T waves, Wellens pattern |
| Prolonged QT | LQTS, drugs (antipsychotics, TCAs, quinidine), hypokalemia, hypomagnesemia, hypocalcemia, hypothermia |
| Short QT | Hypercalcemia, SQTS, digoxin effect |
| Wide QRS | LBBB, RBBB, VT, hyperkalemia, pre-excitation, drug toxicity (TCAs, flecainide) |
| Delta wave | WPW |
| Epsilon wave | ARVC |
| Low voltage | Pericardial effusion/tamponade, COPD, obesity, hypothyroidism, restrictive cardiomyopathy |
| Electrical alternans | Pericardial tamponade |
| Peaked T waves | Hyperacute STEMI, hyperkalemia |
| U waves | Hypokalemia, bradycardia, LVH |
| PR depression | Acute pericarditis |
| Osborn (J) wave | Hypothermia, Brugada, hypercalcemia |
Sources: The Washington Manual of Medical Therapeutics, Harrison's Principles of Internal Medicine 22E, Braunwald's Heart Disease, Goldman-Cecil Medicine, Tintinalli's Emergency Medicine, Fuster & Hurst's The Heart, Rosen's Emergency Medicine.
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