Explain 10 heart disease with ECG change and ECG images of those disease

Reading File

Finding Sources

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ECG changes myocardial infarction ST elevation

Finding Sources

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atrial fibrillation ECG irregular rhythm no P waves

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complete heart block third degree AV block ECG

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Wolff-Parkinson-White syndrome ECG delta wave short PR

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hypertrophic cardiomyopathy ECG left ventricular hypertrophy

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pericarditis ECG saddle shaped ST elevation diffuse

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Brugada syndrome ECG coved ST elevation V1 V2 V3

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long QT syndrome ECG prolonged QT interval torsades de pointes

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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia

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dilated cardiomyopathy ECG left bundle branch block poor R wave progression

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hyperkalemia ECG peaked T waves wide QRS sine wave

Here is a comprehensive guide to 10 heart diseases and their characteristic ECG changes, with clinical ECG images for each.

10 Heart Diseases with ECG Changes

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Changes

Hyperacute T waves — earliest sign (peaked, broad T waves)
ST-segment elevation ≥1 mm in ≥2 contiguous leads (convex/tombstone morphology)
Reciprocal ST depression in opposing leads
Pathological Q waves — develop within hours (>25% of R wave height, >40 ms wide)
T-wave inversion in the evolving/chronic phase

Territory	Leads with ST Elevation	Artery
Anterior	V1–V4	LAD
Inferior	II, III, aVF	RCA
Lateral	I, aVL, V5–V6	LCx
Posterior	V1–V3 (tall R + ST depression)	RCA/LCx

ECG Image — Anterior STEMI (LAD occlusion)

12-lead ECG showing convex ST elevation in V1–V6 with hyperacute T waves and reciprocal inferior ST depression. Classic proximal LAD occlusion pattern.

ECG Image — Inferior STEMI with posterior extension

ST elevation in II, III, aVF with reciprocal depression in I and aVL; tall R waves and ST depression V1–V3 indicating posterior involvement.

2. 💓 Atrial Fibrillation (AF)

ECG Changes

Absent P waves — replaced by chaotic fibrillatory (f) waves, most visible in V1
Irregularly irregular RR intervals — hallmark feature
Narrow QRS complexes (unless aberrant conduction or pre-excitation)
Rate: can be rapid (>100 bpm), controlled, or slow
Fine vs. coarse f waves (coarse may mimic flutter)

ECG Image — Atrial Fibrillation

Classic AF: completely irregular R-R intervals, absent P waves, fine f waves most prominent in V1. Rapid ventricular response ~126 bpm.

3. 🔇 Complete (Third-Degree) AV Heart Block

ECG Changes

Complete AV dissociation — P waves and QRS complexes are totally independent
Atrial rate > ventricular escape rate
Regular P-P intervals and regular R-R intervals but NO consistent relationship
Wide QRS (>120 ms) if ventricular escape focus; narrow if junctional escape
Bradycardia — escape rate 20–40 bpm (ventricular) or 40–60 bpm (junctional)

ECG Image — Complete Heart Block

Third-degree AV block: P waves march through QRS complexes with no fixed PR interval. Wide ventricular escape complexes at a slow rate.

4. ⚡ Wolff-Parkinson-White (WPW) Syndrome

ECG Changes

Short PR interval (<120 ms) — rapid conduction through accessory pathway
Delta wave — slurred upstroke at onset of QRS (pre-excitation of ventricle)
Wide QRS — total duration >120 ms (delta + normal conduction fusion)
Secondary ST-T changes — discordant from QRS
Delta wave polarity localizes the accessory pathway
Risk: AF with pre-excitation can cause ventricular fibrillation

ECG Image — WPW Syndrome

Classic WPW triad: short PR interval, prominent delta waves (slurred initial QRS), and broadened QRS complexes. Pathway localized by delta wave polarity.

5. 🧱 Hypertrophic Cardiomyopathy (HCM)

ECG Changes

Left ventricular hypertrophy (LVH) — increased QRS voltage (Sokolow-Lyon: S V1 + R V5 > 35 mm)
Deep, symmetric T-wave inversions — especially lateral and precordial leads; "giant" negative T waves in apical HCM (Yamaguchi pattern)
Strain pattern — ST depression with T-wave inversion in V4–V6, I, aVL
Absence of septal Q waves in I, aVL, V5–V6 (abnormal septal depolarization)
Abnormal Q waves in inferior/lateral leads mimicking infarction

ECG Image — HCM with Apical Variant

Apical HCM (Yamaguchi syndrome): high-voltage QRS in V4–V6 with giant deep T-wave inversions in V2–V5 — classic "ace of spades" apical morphology.

ECG Image — Septal HCM with strain pattern

Septal HCM: LVH voltage criteria, ST depression and deep T inversions V2–V6, aVL, and a positive T wave in aVR (high arrhythmic risk marker).

6. 🔥 Acute Pericarditis

ECG Changes (Classically Evolves Through 4 Stages)

Stage	ECG Finding
I	Diffuse concave (saddle-shaped) ST elevation in all leads except aVR/V1; PR depression
II	ST returns to baseline; PR depression persists
III	T-wave inversion (diffuse)
IV	ECG normalizes

PR segment depression — most specific finding (due to atrial epicarditis); reciprocal PR elevation in aVR
Spodick's sign — downward slope of TP segment
ST elevation is diffuse (not territory-specific), and there are no reciprocal ST depressions (unlike STEMI)

ECG Image — Acute Pericarditis

Diffuse saddle-shaped ST elevation in I, II, III, aVF, V2–V6 with PR depression in II and Spodick's sign. Sinus tachycardia from systemic inflammation.

7. 🧬 Brugada Syndrome

ECG Changes

Three ECG patterns recognized:

Pattern	ST Morphology	Diagnostic
Type 1 (coved)	J-point ≥2 mm, convex/coved ST descending to inverted T	Diagnostic of Brugada syndrome
Type 2 (saddle-back)	J-point ≥2 mm, saddle-back ST with positive T	Not diagnostic alone
Type 3	<2 mm elevation, saddle-back	Not diagnostic

Location: V1–V3 (or V1–V2 with leads placed in 3rd/2nd intercostal space)
Spontaneous Type 1 is most significant; provocation with ajmaline/flecainide can unmask
Risk of polymorphic VT and sudden cardiac death, especially at rest/night

ECG Image — Brugada Type 1

Classic Type 1 Brugada coved pattern: J-point elevation ≥2 mm in V1–V2 with convex, downward-sloping ST descending into inverted T wave.

8. 🔁 Long QT Syndrome (LQTS)

ECG Changes

Prolonged QTc interval — QTc >440 ms (men), >460 ms (women); >500 ms = high risk
T-wave abnormalities — broad, notched, or biphasic T waves
T-wave alternans — beat-to-beat variation in T-wave morphology (severe LQTS)
Torsades de Pointes (TdP) — polymorphic VT that "twists" around the isoelectric line; triggered by R-on-T

LQTS Subtype	T-Wave Pattern	Trigger
LQT1	Broad-based T wave	Exercise
LQT2	Notched/bifid T wave	Auditory stimuli
LQT3	Late-onset, peaked T wave	Rest/sleep

ECG Image — LQTS with Torsades de Pointes

Marked QTc prolongation with R-on-T phenomenon triggering classic torsades de pointes — polymorphic VT twisting around the isoelectric baseline.

9. 🩸 Acute Pulmonary Embolism (PE)

ECG Changes

Sinus tachycardia — most common finding (80%)
S1Q3T3 pattern (McGinn-White sign) — S wave in I, Q wave and inverted T in III
Right bundle branch block (RBBB) — complete or incomplete, due to acute RV pressure overload
T-wave inversions V1–V4 — RV strain pattern
Right axis deviation
P pulmonale — peaked P waves in II (right atrial enlargement)
Atrial arrhythmias — AF, flutter from RV dilation

ECG Image — Pulmonary Embolism with S1Q3T3

PE with right heart strain: sinus tachycardia, S1Q3T3 pattern (prominent S in I, Q and inverted T in III), T inversions V1–V3, incomplete RBBB morphology.

10. 🫁 Dilated Cardiomyopathy (DCM)

ECG Changes

Left bundle branch block (LBBB) — broad notched R waves in I, aVL, V5–V6; deep S in V1–V3; >120 ms QRS
Left ventricular hypertrophy — increased voltage criteria
Poor R-wave progression in precordial leads (V1–V4 fail to develop normal R waves)
Non-specific ST-T changes — ST depression, T-wave flattening or inversion
Pathological Q waves — from fibrosis/scar mimicking infarction
Atrial fibrillation or flutter — from atrial dilatation
Ventricular ectopy — frequent PVCs, NSVT
Prolonged PR interval (1st degree AV block)

ECG Image — Dilated Cardiomyopathy with LBBB

LBBB in DCM: wide QRS >120 ms, broad monophasic R waves in I/aVL/V5–V6, deep S waves in V1–V3, discordant ST-T changes. Often an indication for CRT.

Quick Reference Summary Table

#	Disease	Key ECG Finding
1	STEMI	ST elevation (convex) + reciprocal depression + Q waves
2	Atrial Fibrillation	Irregular RR, absent P waves, f-waves
3	Complete AV Block	P-QRS dissociation, bradycardia, escape rhythm
4	WPW Syndrome	Short PR + delta wave + wide QRS
5	Hypertrophic Cardiomyopathy	LVH + giant T inversions (apical) or strain pattern
6	Acute Pericarditis	Diffuse saddle ST elevation + PR depression
7	Brugada Syndrome	Coved ST elevation V1–V3 + inverted T wave
8	Long QT Syndrome	Prolonged QTc + T-wave abnormalities + TdP
9	Pulmonary Embolism	S1Q3T3 + sinus tachycardia + RBBB + RV strain
10	Dilated Cardiomyopathy	LBBB + poor R progression + arrhythmias

Sources: Braunwald's Heart Disease (10th ed.), Rosen's Emergency Medicine; ECG images from PMC Clinical VQA database.

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