Ecg changes with images top 10

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ECG changes electrocardiogram patterns STEMI ST elevation myocardial infarction

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ECG hyperkalemia peaked T waves QRS widening sine wave pattern

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atrial fibrillation ECG irregularly irregular no P waves

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Wolff-Parkinson-White syndrome ECG delta wave short PR interval

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complete heart block third degree AV block ECG P waves dissociation

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pericarditis ECG saddle shaped ST elevation PR depression diffuse

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left bundle branch block LBBB ECG broad QRS notched R wave

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Brugada syndrome ECG coved ST elevation V1 V2 right bundle branch pattern

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long QT syndrome torsades de pointes ECG twisting QRS axis polymorphic VT

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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia

I now have excellent images for all 10 ECG patterns. Let me compile the comprehensive answer.

Top 10 ECG Changes — With Images

1. 🫀 STEMI — ST-Elevation Myocardial Infarction

Key ECG Features:

Convex ("tombstone") ST elevation ≥1 mm in ≥2 contiguous limb leads or ≥2 mm in precordial leads
Reciprocal ST depression in opposing leads
Hyperacute T waves (earliest sign)
Q waves (evolve over hours — sign of necrosis)
T-wave inversion (late sign)

Territories:

Territory	ST Elevation	Reciprocal Changes	Culprit Vessel
Inferior	II, III, aVF	aVL, I	RCA or LCx
Anterior	V1–V4	II, III, aVF	LAD
Anterolateral	V1–V6, I, aVL	II, III, aVF	LAD (proximal)
Lateral	I, aVL, V5–V6	aVF	LCx diagonal

Inferior STEMI (Tombstone Pattern)

Inferior STEMI with tombstone ST elevations in II, III, aVF

Anterolateral STEMI

Inferolateral STEMI with annotated leads

Inferolateral STEMI — green circles = ST elevation, yellow arrows = reciprocal depression

2. 🔥 Pericarditis

Key ECG Features (4 stages):

Stage 1 (acute): Diffuse concave ("saddle-shaped") ST elevation in nearly all leads; PR depression (most specific) in II, V4–V6; PR elevation in aVR
Stage 2: ST normalises, T-wave flattening
Stage 3: T-wave inversion
Stage 4: Normalisation

Distinguishing from STEMI: ST elevation is diffuse (not territory-limited), concave (not convex), PR depression is present, no reciprocal ST depression (except aVR).

Spodick's sign: Downsloping TP segment in multiple leads — highly specific.

Acute pericarditis — diffuse saddle-shaped ST elevation, PR depression, Spodick's sign annotated

3. ⚡ Atrial Fibrillation (AF)

Key ECG Features:

Absent P waves — replaced by chaotic fibrillatory (f) waves (best seen in V1, II)
Irregularly irregular R-R intervals (hallmark)
Narrow QRS complexes (unless aberrant conduction)
Ventricular rate 100–160 bpm if uncontrolled

Coarse AF (f waves >1 mm) vs fine AF (f waves <1 mm — may look like isoelectric baseline).

Atrial fibrillation — irregularly irregular rhythm, absent P waves, fine fibrillatory baseline

4. 🔌 Complete (Third-Degree) AV Block

Key ECG Features:

Complete AV dissociation — P waves and QRS complexes march independently
Atrial rate > ventricular escape rate
Regular P-P intervals AND regular R-R intervals (both regular, but unrelated)
Escape QRS morphology:
- Narrow (junctional escape, rate 40–60 bpm) — higher block
- Wide (ventricular escape, rate 20–40 bpm) — infranodal block

Third-degree complete AV block — P waves march through QRS complexes with AV dissociation

5. 🌩 Hyperkalemia

Key ECG Features (progressive with rising K⁺):

K⁺ Level	ECG Change
5.5–6.5 mEq/L	Tall, peaked ("tented") T waves — narrow base, symmetric
6.5–7.5 mEq/L	Prolonged PR, flattened/absent P waves
7.5–8.0 mEq/L	Widened QRS (intraventricular conduction delay)
>8.0 mEq/L	Sine wave pattern → VF → asystole

Hyperkalemia ECG — peaked tented T waves with QRS widening, approaching sine wave

Severe hyperkalemia — sine wave morphology, absent P waves, broad-complex tachycardia

6. 🚧 Left Bundle Branch Block (LBBB)

Key ECG Features (WiLLiaM mnemonic — W in V1, M in V6):

QRS ≥120 ms (complete LBBB)
Deep, broad S waves in V1–V3
Broad, notched ("M-shaped" or monophasic) R waves in I, aVL, V5–V6
No septal Q waves in lateral leads
Discordant ST-T changes (ST and T wave opposite to QRS direction)
Left axis deviation common

Clinical pearl: New LBBB in the context of chest pain = treat as STEMI equivalent (Sgarbossa criteria apply).

Classic LBBB — broad notched R waves V5–V6, deep S waves V1–V3, discordant ST-T changes

7. ⚠️ Brugada Syndrome (Type 1 Pattern)

Key ECG Features:

Coved ST elevation ≥2 mm in V1–V2 with a descending ST segment directly into an inverted T wave (no isoelectric gap)
Pseudo-RBBB morphology
Normal QRS duration
No actual structural heart disease

Three Brugada patterns:

Type	Morphology	Clinical Significance
Type 1 (coved)	ST ≥2 mm coved + inverted T	Diagnostic
Type 2 (saddle-back)	ST ≥1 mm with upright/biphasic T	Suggestive, needs provocation
Type 3	ST <1 mm	Not diagnostic alone

Associated with SCN5A mutation (sodium channel), risk of sudden cardiac death.

Brugada Type 1 — coved ST elevation V1–V2 with inverted T waves, incomplete RBBB pattern

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

Key ECG Features (classic triad):

Short PR interval (<120 ms) — accessory pathway bypasses AV node
Delta wave — slurred upstroke at start of QRS (pre-excitation)
Widened QRS >120 ms (due to fusion of normal + accessory conduction)
Secondary ST-T changes — discordant with QRS

Localising the accessory pathway: Delta wave polarity in various leads predicts location (e.g., positive delta in V1 = left-sided pathway; negative delta in inferior leads = posteroseptal pathway).

Risk: WPW + AF can conduct at very high rates via accessory pathway → pre-excited AF → VF.

WPW — short PR, prominent delta waves, widened QRS in V2–V6 and inferior leads

9. 🌀 Torsades de Pointes (TdP) / Long QT Syndrome

Long QT ECG:

QTc >450 ms (men), >460 ms (women) — corrected with Bazett's formula
T-wave morphology abnormalities (bifid T waves in LQT2, broad-based in LQT1)

Torsades de Pointes ECG:

Polymorphic ventricular tachycardia with QRS complexes that appear to "twist" around the isoelectric baseline
Rate 200–250 bpm
Classic initiator: pause-dependent onset (long-short RR sequence)
Preceded by prolonged QT on baseline ECG

Common causes: Electrolyte disturbances (↓K⁺, ↓Mg²⁺), drugs (antiarrhythmics, antipsychotics, antibiotics), congenital LQTS.

Treatment: IV magnesium sulfate 2g, overdrive pacing, remove offending agents.

Torsades de Pointes — polymorphic VT with QRS complexes twisting around isoelectric line

10. 🫁 Pulmonary Embolism (PE)

Key ECG Features (right heart strain pattern):

Sinus tachycardia — most common finding (seen in >40%)
S1Q3T3 pattern — S wave in lead I, Q wave + T-wave inversion in lead III (seen in ~20%)
Right axis deviation
Incomplete or complete RBBB
T-wave inversions V1–V4 (right ventricular strain)
P pulmonale (tall P wave >2.5 mm in II)
Right precordial ST changes

None of these changes are specific — ECG is primarily used to exclude other diagnoses (e.g., STEMI, pericarditis) in suspected PE.

Pulmonary embolism ECG — S1Q3T3 pattern with sinus tachycardia, annotated with arrows

PE right heart strain — S1Q3T3, incomplete RBBB, T-wave inversions V1–V4

Quick Reference Summary

#	Condition	Key ECG Finding	Emergency?
1	STEMI	Convex ST elevation + reciprocal depression	🔴 Yes — PCI
2	Pericarditis	Diffuse concave ST elevation + PR depression	🟡 Urgent eval
3	Atrial Fibrillation	Absent P waves, irregular R-R	🟡 Rate/rhythm control
4	Complete AV Block	AV dissociation, slow escape	🔴 Yes — pacing
5	Hyperkalemia	Peaked T → sine wave	🔴 Yes — calcium IV
6	LBBB	Wide QRS, notched R V6, deep S V1	🟡 If new + chest pain
7	Brugada	Coved ST V1–V2, inverted T	🔴 ICD referral
8	WPW	Short PR + delta wave	🟡 Ablation referral
9	Torsades de Pointes	Twisting polymorphic VT	🔴 Yes — Mg²⁺ IV
10	Pulmonary Embolism	S1Q3T3, sinus tachycardia	🔴 Yes — anticoagulation

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