Explain me 10 common heart disease with ECG diagram and ECG images of those disease
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ECG diagrams 10 common heart diseases atrial fibrillation MI heart block LBBB images
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ECG normal sinus rhythm atrial fibrillation myocardial infarction diagram labeled wikimedia
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ECG images ventricular tachycardia heart block STEMI LBBB Wolff-Parkinson-White clinical wikimedia commons
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ECG STEMI heart attack ST elevation complete heart block third degree ventricular fibrillation torsades de pointes images
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ECG left bundle branch block LBBB right bundle branch block RBBB hypertrophic cardiomyopathy Wolff-Parkinson-White delta wave clinical ECG strip
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Here is a thorough guide to 10 common heart diseases with their ECG features and available images.
ECG Basics - Understanding the Waveform
Before diving into the diseases, here is the normal ECG waveform for reference:
| Waveform | What It Represents |
|---|---|
| P wave | Atrial depolarization (SA node firing) |
| PR interval | Conduction from atria to ventricles (0.12-0.20 s) |
| QRS complex | Ventricular depolarization (<0.12 s) |
| ST segment | Isoelectric period between depolarization and repolarization |
| T wave | Ventricular repolarization |
| QT interval | Total ventricular electrical activity |
10 Common Heart Diseases with ECG Findings
1. Atrial Fibrillation (AF)
What it is: The most common cardiac arrhythmia. Disorganized electrical activity in the atria causes rapid, chaotic impulses (350-600/min) that produce an irregular ventricular response.
Causes: Hypertension, heart failure, valvular disease, thyrotoxicosis, alcohol excess, sleep apnea.
Symptoms: Palpitations, shortness of breath, fatigue, stroke risk (5x increased).
ECG Features:
- No visible P waves - replaced by fibrillatory (f) waves
- Irregularly irregular RR intervals (no pattern)
- Narrow QRS (unless aberrant conduction or bundle branch block present)
- Ventricular rate typically 100-160 bpm if uncontrolled
2. ST-Elevation Myocardial Infarction (STEMI)
What it is: A complete occlusion of a coronary artery causing full-thickness (transmural) myocardial infarction. A true cardiac emergency requiring immediate revascularization.
Causes: Rupture of atherosclerotic plaque with thrombosis.
Symptoms: Severe crushing chest pain, diaphoresis, nausea, radiation to arm/jaw.
ECG Features (sequential evolution):
- Hyperacute T waves - earliest sign (tall, broad T waves)
- ST elevation ≥1 mm in 2 contiguous limb leads, or ≥2 mm in 2 contiguous precordial leads
- Pathological Q waves develop over hours to days (>40ms wide, >25% of R wave height)
- T wave inversion follows reperfusion or infarct evolution
- Reciprocal ST depression in opposite leads
- Lead localization: V1-V4 = anterior (LAD); II, III, aVF = inferior (RCA); I, aVL, V5-V6 = lateral (LCx)
Source: Harrison's Principles of Internal Medicine 22E - "ECG findings are ST elevation suggesting infarction, but also include conduction block, tachyarrhythmias, and nonspecific ST-T changes."
3. Left Bundle Branch Block (LBBB)
What it is: Failure of conduction down the left bundle branch. The left ventricle is depolarized late via the right ventricle, producing a wide, abnormal QRS.
Causes: Coronary artery disease, hypertension, aortic stenosis, cardiomyopathy. New LBBB with chest pain is a STEMI-equivalent until proven otherwise.
Symptoms: Often asymptomatic; may cause reduced cardiac output in diseased hearts.
ECG Features (use the WiLLiaM MaRRoW mnemonic):
- QRS duration ≥120 ms (broad)
- V1: Dominant S wave (rS or QS pattern) - deep, broad
- V6/I/aVL: Broad, notched or "M-shaped" R wave - no Q waves in lateral leads
- ST and T wave changes are discordant (opposite to QRS direction)
- No septal Q waves in lateral leads
4. Right Bundle Branch Block (RBBB)
What it is: Conduction block in the right bundle branch. The right ventricle depolarizes late, producing a characteristic "M-shaped" pattern in V1.
Causes: Pulmonary embolism (acute RBBB), right heart strain, congenital heart disease, after cardiac surgery, can be a normal variant.
ECG Features (MaRRoW mnemonic for V1):
- QRS duration ≥120 ms
- V1: RSR' pattern - "M-shaped" or "rabbit ears" (rSR')
- V5-V6/I: Wide, slurred S wave (the late right ventricular activation)
- ST/T wave changes in V1-V3 (secondary)
- Right axis deviation may be present
(The LBBB vs RBBB comparison image above shows both patterns clearly across V1-V6)
5. Complete (Third-Degree) Heart Block
What it is: Complete dissociation between atria and ventricles. No atrial impulse conducts to the ventricles. The ventricles are maintained by an escape rhythm (junctional or ventricular).
Causes: Inferior STEMI (RCA occlusion), degenerative conduction system disease (Lenegre/Lev disease), medications (beta-blockers, digoxin), Lyme disease, post-cardiac surgery.
Symptoms: Syncope (Stokes-Adams attacks), extreme bradycardia, heart failure, sudden death.
ECG Features:
- P waves and QRS complexes march independently - complete AV dissociation
- P waves at their own rate (usually sinus, ~60-100 bpm)
- QRS at a slower escape rate (junctional = narrow QRS at 40-60 bpm; ventricular = wide QRS at 20-40 bpm)
- No consistent PR interval - it changes with every beat
- PP intervals are regular; RR intervals are regular - but they are NOT related to each other
6. Ventricular Tachycardia (VT)
What it is: A dangerous arrhythmia originating in the ventricles at a rate >100 bpm (usually 120-250 bpm). Can degenerate into ventricular fibrillation and cardiac arrest.
Causes: Ischemic heart disease (most common), cardiomyopathy, electrolyte disturbances (hypokalemia, hypomagnesemia), drugs (QT-prolonging agents), channelopathies.
Symptoms: Palpitations, presyncope, syncope, hemodynamic collapse.
ECG Features:
- Wide QRS complexes (>120ms), bizarre morphology
- Rate 120-250 bpm, regular
- AV dissociation (P waves visible, marching independently) - pathognomonic when seen
- Fusion beats and capture beats (specific signs of VT, not SVT)
- Concordance in precordial leads (all QRS positive or all negative)
- Brugada criteria / RBBB with left axis deviation patterns
(Above: Non-sustained VT (NSVT) shown with wide-complex tachycardia, transitioning to AF with LBBB morphology)
7. Wolff-Parkinson-White (WPW) Syndrome
What it is: A pre-excitation syndrome caused by an accessory pathway (Bundle of Kent) that bypasses the AV node, allowing early ventricular activation (pre-excitation). Can cause life-threatening tachyarrhythmias including AF with rapid ventricular conduction.
Causes: Congenital - the accessory pathway is present from birth.
Symptoms: Palpitations, syncope, sudden cardiac death (especially in athletes).
ECG Features (the "delta wave triad"):
- Short PR interval (<120 ms) - bypass tract skips slow AV node conduction
- Delta wave - slurred upstroke at the start of the QRS (early ventricular activation)
- Wide QRS (>120 ms) - because ventricular muscle is depolarized via slow muscle-to-muscle spread
- Pseudo-LBBB or RBBB pattern depending on pathway location
- ST/T wave changes opposite to QRS (discordant)
- Risk: AF in WPW can conduct 1:1 via the accessory pathway → rapid VF → sudden death
8. Ventricular Fibrillation (VF)
What it is: Completely disorganized ventricular electrical activity with no effective contraction. Produces no cardiac output. Rapidly fatal without immediate defibrillation.
Causes: Acute STEMI (most common), VT degeneration, electrocution, hypokalemia/hypomagnesemia, drug toxicity, hypothermia, Brugada syndrome.
ECG Features:
- Chaotic, irregular, high-frequency oscillations - no recognizable P waves, QRS, or T waves
- Variable amplitude waveforms (coarse VF = larger amplitude, finer VF = smaller amplitude)
- No organized rhythm whatsoever
- Coarse VF is more likely to respond to defibrillation than fine VF
- Diagnosis is clinical + ECG - no pulse, no output
LITFL ECG Library: "Ventricular fibrillation is the most important shockable cardiac arrest rhythm. It is invariably fatal unless advanced life support is rapidly instituted."
9. Atrial Flutter
What it is: A macro-reentrant tachyarrhythmia originating in the right atrium, circulating around the tricuspid valve annulus at approximately 300 bpm. Typically conducts to ventricles with a fixed block (2:1, 3:1, or 4:1).
Causes: Same as atrial fibrillation - structural heart disease, hypertension, post-cardiac surgery, pulmonary disease.
Symptoms: Palpitations, dyspnea, reduced exercise tolerance.
ECG Features:
- "Sawtooth" flutter waves (F waves) at ~300 bpm - best seen in II, III, aVF and V1
- Regular ventricular rate (common 2:1 block → ventricular rate ~150 bpm)
- No isoelectric baseline between flutter waves
- Narrow QRS (unless aberrant conduction)
- 2:1 block: ventricular rate exactly 150 bpm should always raise suspicion for flutter
- Variable block (4:1, 3:1) produces slower ventricular rates
10. Left Ventricular Hypertrophy (LVH)
What it is: Pathological thickening of the left ventricular wall due to chronic pressure overload (hypertension, aortic stenosis) or volume overload. Associated with increased risk of arrhythmia, heart failure, and sudden death.
Causes: Hypertension (most common), aortic stenosis, hypertrophic cardiomyopathy, athletic remodeling (physiologic LVH).
Symptoms: Often asymptomatic; may cause exertional dyspnea, angina (from subendocardial ischemia).
ECG Features (Sokolow-Lyon criteria most commonly used):
- Increased QRS voltage:
- S wave in V1 + R wave in V5 or V6 ≥35 mm (Sokolow-Lyon)
- R wave in aVL ≥11 mm (Cornell criterion)
- R wave in V5 or V6 ≥26 mm
- "Strain pattern" - ST depression and T wave inversion in lateral leads (I, aVL, V5-V6)
- Left axis deviation
- Prolonged QRS (slight widening, but <120ms)
- Wide P wave or notched P wave (left atrial enlargement often coexists)
The 12-lead ECG below (from stemlynsblog) shows a patient with LVH - note the tall R waves in lateral leads and deep S waves in V1-V3:
Summary Table
| # | Disease | Key ECG Finding | Heart Rate | Rhythm |
|---|---|---|---|---|
| 1 | Atrial Fibrillation | No P waves, f waves, irregular RR | 100-160 (uncontrolled) | Irregularly irregular |
| 2 | STEMI | ST elevation + pathological Q waves | Variable | Regular (unless arrhythmia) |
| 3 | LBBB | Wide QRS, dominant S in V1, broad R in V6 | Variable | Regular |
| 4 | RBBB | Wide QRS, RSR' in V1 ("rabbit ears"), slurred S in V6 | Variable | Regular |
| 5 | Complete Heart Block | P and QRS dissociated; slow QRS escape | 20-60 bpm (ventricles) | Regular but dissociated |
| 6 | Ventricular Tachycardia | Wide QRS, AV dissociation, fusion beats | 120-250 bpm | Regular |
| 7 | WPW Syndrome | Short PR, delta wave, wide QRS | Variable | Variable |
| 8 | Ventricular Fibrillation | Chaotic, no recognizable waveforms | Undetectable | Absent |
| 9 | Atrial Flutter | Sawtooth F waves ~300 bpm, regular ventricular rate | ~150 bpm (2:1) | Regular |
| 10 | LVH | Tall voltage, strain pattern, LAD | Variable | Regular |
Clinical Pearls
- Any wide complex tachycardia (WCT) = VT until proven otherwise - do not assume it is SVT with aberrancy
- New LBBB + chest pain = STEMI equivalent - treat accordingly
- Ventricular rate exactly 150 bpm should always raise suspicion for atrial flutter with 2:1 block
- WPW + AF is dangerous - avoid AV node blocking drugs (adenosine, verapamil, digoxin) as they may accelerate conduction via the accessory pathway and trigger VF
- Complete heart block post-inferior MI is usually transient; post-anterior MI complete heart block is an ominous sign
Sources: Harrison's Principles of Internal Medicine 22E; Goldman-Cecil Medicine; Tintinalli's Emergency Medicine; Guyton and Hall Medical Physiology; LITFL ECG Library
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