Explain 10 heart dease and ecg emage with example
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ECG patterns 10 heart diseases examples images explained
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STEMI atrial fibrillation ventricular tachycardia heart block ECG images examples
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STEMI ECG example image site:litfl.com OR site:ecgwaves.com
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atrial flutter complete heart block Wolff-Parkinson-White long QT syndrome ECG image litfl
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10 Heart Diseases and Their ECG Patterns
An ECG records the heart's electrical activity across time. Each disease leaves a recognizable fingerprint on the tracing. Below are 10 important heart diseases with their ECG features and real ECG examples.
Quick Reference: Killer ECG Patterns
1. ST-Elevation Myocardial Infarction (STEMI)
What it is: A complete blockage of a coronary artery causing full-thickness (transmural) heart muscle death. The most time-critical cardiac emergency.
ECG findings:
- ST elevation ≥ 1 mm in 2 or more contiguous limb leads, or ≥ 2 mm in 2 or more contiguous precordial leads
- Hyperacute (tall, broad) T waves in the early phase
- Pathological Q waves develop later (sign of completed infarction)
- Reciprocal ST depression in opposite leads
Example: Anterior STEMI shows ST elevation in V2-V4, with reciprocal depression in inferior leads (II, III, aVF).
Clinical note: "Time is muscle" - every 30-minute delay in reperfusion leads to significant additional myocardial loss. Target door-to-balloon time is <90 minutes. - Tintinalli's Emergency Medicine
2. Atrial Fibrillation (AF)
What it is: Chaotic, disorganized electrical activity in the atria. The most common sustained cardiac arrhythmia, affecting ~2-3% of the general population.
ECG findings:
- No visible P waves (replaced by irregular fibrillatory baseline)
- Irregularly irregular RR intervals (the hallmark feature)
- Normal QRS complexes (unless aberrant conduction)
- Rate typically 100-160 bpm if uncontrolled
Risks: Stroke (5x increased risk), heart failure, hemodynamic compromise. Requires anticoagulation assessment using CHA₂DS₂-VASc score.
3. Atrial Flutter
What it is: A rapid, organized atrial circuit (usually in the right atrium) producing a regular atrial rate of ~300 bpm with variable conduction to the ventricles.
ECG findings:
- Classic "sawtooth" or "picket-fence" flutter waves at ~300 bpm in inferior leads (II, III, aVF)
- Flutter waves are upright in V1
- Ventricular rate is a regular fraction: 2:1 (150 bpm), 3:1 (100 bpm), or 4:1 (75 bpm)
- Regular QRS complexes
Tip: When you see a regular narrow-complex tachycardia at 150 bpm, always suspect 2:1 flutter until proven otherwise.
4. Ventricular Tachycardia (VT)
What it is: A life-threatening arrhythmia originating in the ventricles, running at ≥100 bpm. Can degenerate into ventricular fibrillation.
ECG findings:
- Wide QRS complexes (>120 ms) at rate 100-250 bpm
- AV dissociation (P waves independent of QRS - pathognomonic)
- Fusion beats and capture beats (when present, confirm VT)
- Concordance across all precordial leads
Example: A 45-year-old post-MI patient develops sudden palpitations and hypotension. ECG shows wide-complex tachycardia at 180 bpm with AV dissociation = VT until proven otherwise.
5. Ventricular Fibrillation (VF)
What it is: Chaotic, uncoordinated ventricular electrical activity - produces no effective cardiac output. Immediate cause of sudden cardiac death.
ECG findings:
- Completely chaotic, irregular waveforms with no identifiable P, QRS, or T waves
- Irregular amplitude and frequency
- No organized rhythm whatsoever
- Coarse VF (larger amplitude) vs. fine VF (smaller amplitude, worse prognosis)
Management: Immediate defibrillation + CPR. Only shockable rhythm alongside pulseless VT. Survival falls ~10% per minute without defibrillation.
6. Complete (3rd Degree) Heart Block
What it is: Total failure of electrical conduction from atria to ventricles. The atria and ventricles beat independently of each other.
ECG findings:
- P waves present at normal atrial rate (~60-100 bpm)
- QRS complexes at a slower, independent ventricular escape rate (20-40 bpm if below His-Purkinje; 40-60 bpm if junctional)
- No relationship between P waves and QRS complexes (complete AV dissociation)
- Wide QRS if ventricular escape; narrow QRS if junctional escape
Example: An elderly patient presents with syncope. ECG shows P rate 80 bpm, QRS rate 35 bpm, with no relationship between them. Requires urgent pacemaker implantation.
7. Wolff-Parkinson-White (WPW) Syndrome
What it is: A congenital accessory pathway (Bundle of Kent) bypasses the AV node, causing ventricular pre-excitation and predisposing to tachyarrhythmias.
ECG findings (in sinus rhythm):
- Short PR interval (<120 ms) - fast conduction via accessory pathway
- Delta wave - slurred upstroke of the QRS (pre-excitation of ventricle)
- Wide QRS complex (>120 ms)
- ST-T wave changes secondary to abnormal depolarization
The infographic at the top of this article shows the classic delta wave and short PR interval pattern for WPW.
Danger: If AF develops with WPW, AV nodal blocking drugs (beta-blockers, verapamil, digoxin) are CONTRAINDICATED - they can precipitate VF. Use procainamide or cardioversion instead. - LITFL ECG Library
8. Brugada Syndrome
What it is: A genetic channelopathy (usually SCN5A sodium channel mutation) causing sudden cardiac death in young, otherwise healthy individuals with a structurally normal heart.
ECG findings (Type 1 - diagnostic):
- Coved-type ST elevation ≥2 mm in V1-V3
- Followed by a negative T wave (the "coved" pattern)
- QRS widening in right precordial leads
The top infographic clearly shows the classic coved ST elevation with negative T wave in V1-3 that defines Type 1 Brugada pattern.
Clinical pearls:
- May be unmasked by fever, sodium channel blockers (flecainide, procainamide), or tricyclic antidepressants
- Predominantly affects young Asian males
- Treatment for high-risk patients is an implantable defibrillator (ICD)
9. Left Ventricular Hypertrophy (LVH)
What it is: Thickening of the left ventricular muscle wall due to chronic pressure overload (e.g., hypertension, aortic stenosis).
ECG findings:
- Increased QRS voltage: S in V1 + R in V5 or V6 ≥35 mm (Sokolow-Lyon criteria)
- R in aVL ≥11 mm
- Left axis deviation
- "Strain pattern" - ST depression and T-wave inversion in lateral leads (I, aVL, V5-V6)
- Widened QRS (but usually <120 ms)
The first infographic shows LVH with "dagger Q waves" in hypertrophic cardiomyopathy - a more extreme form of hypertrophy.
Example: A 55-year-old hypertensive patient's ECG shows R+S voltage of 42 mm with ST depression in V5-V6 = LVH with strain.
10. Long QT Syndrome (LQTS)
What it is: Prolonged ventricular repolarization (congenital or acquired) that predisposes to a dangerous polymorphic VT called Torsades de Pointes.
ECG findings:
- Prolonged QT interval: corrected QTc >440 ms in males, >460 ms in females
- Abnormal T-wave morphology (notched, bifid, or biphasic T waves depending on subtype)
- QTc >500 ms carries highest risk of Torsades
- Torsades de Pointes: polymorphic VT with characteristic twisting of QRS axis around the baseline
Common causes of acquired LQTS:
| Cause | Examples |
|---|---|
| Drugs | Amiodarone, sotalol, haloperidol, erythromycin, methadone |
| Electrolytes | Hypokalemia, hypomagnesemia, hypocalcemia |
| Congenital | Romano-Ward syndrome (autosomal dominant), Jervell and Lange-Nielsen syndrome |
Rule of thumb: Always check QTc before prescribing QT-prolonging drugs. If QTc >500 ms, risk of Torsades is significant.
EKG Arrhythmia Reference
Summary Table
| # | Disease | Key ECG Feature | Rate | Rhythm |
|---|---|---|---|---|
| 1 | STEMI | ST elevation + Q waves | Normal/fast | Regular |
| 2 | Atrial Fibrillation | No P waves, irregular RR | 100-160 | Irregularly irregular |
| 3 | Atrial Flutter | Sawtooth flutter waves at 300 bpm | 75-150 | Regular |
| 4 | Ventricular Tachycardia | Wide QRS + AV dissociation | 100-250 | Regular |
| 5 | Ventricular Fibrillation | Chaotic, no identifiable complexes | Uncountable | None |
| 6 | Complete Heart Block | P waves & QRS independent | Atria 60-100, Ventricles 20-60 | Regular but dissociated |
| 7 | WPW Syndrome | Short PR + delta wave | Variable | Regular (in sinus) |
| 8 | Brugada Syndrome | Coved ST elevation V1-V3 | Normal | Regular |
| 9 | LVH | High voltage + strain pattern | Normal | Regular |
| 10 | Long QT Syndrome | Prolonged QTc >440 ms | Normal | Regular |
Sources: Braunwald's Heart Disease (Textbook of Cardiovascular Medicine), Tintinalli's Emergency Medicine, Goldman-Cecil Medicine, LITFL ECG Library, NursesLabs EKG Guide
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