10 common heart diseases with ecg changes and 10 ecg those images
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ECG electrocardiogram myocardial infarction ST elevation
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10 common heart diseases ECG changes electrocardiogram findings
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atrial fibrillation ECG irregularly irregular rhythm no P waves
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ventricular tachycardia ECG wide QRS tachycardia
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complete heart block third degree AV block ECG dissociation
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Wolff-Parkinson-White syndrome ECG delta wave short PR
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pericarditis ECG saddle shaped ST elevation diffuse
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pulmonary embolism ECG S1Q3T3 right heart strain
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hypertrophic cardiomyopathy ECG left ventricular hypertrophy
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left bundle branch block LBBB ECG broad notched QRS
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long QT syndrome ECG prolonged QT interval torsades
I now have excellent ECG images for all 10 conditions. Let me compile the comprehensive answer:
10 Common Heart Diseases with ECG Changes
1. 🫀 ST-Elevation Myocardial Infarction (STEMI)
Mechanism: Complete occlusion of a coronary artery → transmural ischemia
ECG Changes:
- Convex ("tombstone") ST elevation ≥1 mm in ≥2 contiguous limb leads or ≥2 mm in precordial leads
- Hyperacute T-waves (tall, peaked) — earliest sign
- Reciprocal ST depression in opposite leads
- Pathological Q waves (>25% of R wave height, >40 ms wide) develop hours later
- T-wave inversion in the evolutionary phase
Localisation:
| Territory | Leads with ST elevation |
|---|---|
| Anterior (LAD) | V1–V4 |
| Inferior (RCA) | II, III, aVF |
| Lateral (LCx) | I, aVL, V5–V6 |
| Posterior | Tall R in V1-V2 + ST depression V1–V3 |
ECG Image — Anterior STEMI (LAD occlusion):
Tombstone ST-elevation in V2–V5 with reciprocal depression in II, III, aVF — proximal LAD occlusion.
2. 🫀 Inferolateral STEMI
ECG Changes:
- ST elevation in II, III, aVF and V4–V6
- Reciprocal ST depression in I, aVL, V2–V3
ECG Image — Inferolateral STEMI:
ST elevation (green circles) in inferior and lateral leads; reciprocal changes (yellow arrows) in I, aVL, V2–V3.
3. 🫀 Atrial Fibrillation (AF)
Mechanism: Chaotic, disorganized atrial electrical activity → no coordinated atrial contraction
ECG Changes:
- Absent P waves replaced by fibrillatory (f) waves (chaotic baseline)
- Irregularly irregular R-R intervals — the hallmark
- Narrow QRS complexes (unless aberrant conduction)
- Ventricular rate 60–180 bpm depending on AV node conduction
ECG Image — Atrial Fibrillation:
Classic AF: absent P waves, fine fibrillatory baseline (best seen in V1), irregularly irregular QRS intervals.
4. 🫀 Ventricular Tachycardia (VT)
Mechanism: Re-entrant circuit or triggered activity originating in the ventricles
ECG Changes:
- Wide QRS complexes (>120 ms), rate 100–250 bpm
- AV dissociation — P waves independent of QRS
- Fusion beats and capture beats (pathognomonic)
- Concordance across precordial leads (all positive or all negative)
- Brugada criteria / Vereckei algorithm used to confirm VT vs SVT with aberrancy
ECG Image — Monomorphic Ventricular Tachycardia:
Regular wide-complex tachycardia, superior axis, positive concordance V1–V6, no visible P waves — monomorphic VT.
5. 🫀 Complete (Third-Degree) AV Block
Mechanism: Total failure of conduction through the AV node or His-Purkinje system
ECG Changes:
- Complete AV dissociation — P waves and QRS complexes march independently
- P-P intervals regular; R-R intervals regular, but at different (slower) rates
- Ventricular escape rhythm: narrow QRS if junctional (40–60 bpm); wide QRS if ventricular (20–40 bpm)
- No relationship between P waves and QRS
ECG Image — Third-Degree Heart Block:
P waves "march through" the QRS complexes and T waves with no fixed PR relationship — complete heart block.
6. 🫀 Wolff-Parkinson-White (WPW) Syndrome
Mechanism: Accessory pathway (Bundle of Kent) bypasses the AV node → ventricular pre-excitation
ECG Changes (Pre-excitation Triad):
- Short PR interval (<120 ms)
- Delta wave — slurred upstroke of the QRS (initial slow ventricular activation via accessory pathway)
- Widened QRS (>120 ms) due to fusion of pre-excited and normally conducted impulses
- Secondary ST-T changes (discordant to QRS)
- Risk of AF with rapid conduction → VF (avoid AV nodal blockers)
ECG Image — WPW Syndrome:
Classic WPW triad: short PR interval, prominent delta waves (slurred QRS upstroke in II, III, aVF, V2–V6), and QRS widening.
7. 🫀 Acute Pericarditis
Mechanism: Pericardial inflammation irritates superficial epicardium → diffuse repolarization changes
ECG Changes (4 Stages):
- Stage 1 (acute): Diffuse concave ("saddle-shaped") ST elevation in all leads except aVR and V1; PR segment depression (highly specific); PR elevation in aVR
- Stage 2: ST normalizes, T waves flatten
- Stage 3: T-wave inversion
- Stage 4: Normalization
- Spodick's sign — downward sloping TP segment
Key differentiator from STEMI: Diffuse (multi-territory) ST elevation, PR depression, no reciprocal changes (except aVR)
ECG Image — Acute Pericarditis:
Diffuse saddle-shaped ST elevation with PR segment depression in II, III, aVF, V4–V6 and reciprocal PR elevation in aVR — classic Stage 1 pericarditis.
8. 🫀 Pulmonary Embolism (PE)
Mechanism: Acute right heart strain from increased pulmonary vascular resistance
ECG Changes:
- S1Q3T3 pattern — deep S in lead I, Q wave in lead III, T-wave inversion in lead III (classic but present in only ~20%)
- Sinus tachycardia — most common finding
- T-wave inversions V1–V4 (right ventricular strain pattern)
- Incomplete or complete RBBB
- Right axis deviation
- P pulmonale (tall peaked P in II) in severe cases
ECG Image — Pulmonary Embolism with S1Q3T3:
S1Q3T3 pattern annotated with circles/arrows: deep S in I, Q wave in III, T-wave inversion in III — sinus tachycardia with right heart strain.
9. 🫀 Hypertrophic Cardiomyopathy (HCM)
Mechanism: Asymmetric septal hypertrophy → abnormal depolarization/repolarization
ECG Changes:
- Left ventricular hypertrophy (LVH) voltage criteria: S in V1 + R in V5/V6 ≥35 mm (Sokolow-Lyon)
- "Giant" deep T-wave inversions in V3–V5 (especially in apical HCM / Yamaguchi syndrome)
- Deep Q waves in lateral leads (I, aVL, V5–V6) from septal depolarization
- ST depression with strain pattern
- Left axis deviation
- Short PR (sometimes)
ECG Image — Hypertrophic Cardiomyopathy (Apical variant):
High-voltage QRS with deep, symmetric "giant" T-wave inversions V2–V5 — characteristic of apical HCM (Yamaguchi syndrome).
10. 🫀 Left Bundle Branch Block (LBBB)
Mechanism: Block in the left bundle branch → abnormal septal and LV activation (right-to-left)
ECG Changes (William: WiLLiaM mnemonic):
- Wide QRS (>120 ms)
- Broad, notched ("M-shaped") R wave in lateral leads I, aVL, V5, V6 — no septal Q waves
- Deep, broad rS or QS pattern in V1–V3
- Discordant ST-T changes (ST and T opposite to main QRS deflection)
- Left axis deviation
- New LBBB + chest pain = treat as STEMI equivalent (Sgarbossa criteria)
ECG Image — Left Bundle Branch Block:
Broad M-shaped R waves in V5–V6/I/aVL; deep S waves V1–V3; discordant ST-T changes — classic LBBB.
🔟 + Bonus: Long QT Syndrome (LQTS)
Mechanism: Impaired cardiac repolarization (channelopathy or drug-induced) → prolonged QT interval → risk of Torsades de Pointes (TdP) and sudden death
ECG Changes:
- Prolonged QTc (>440 ms men, >460 ms women) — calculated with Bazett formula: QTc = QT/√RR
- T-wave abnormalities: broad notched (LQT1), late-onset peaked (LQT2), small T with large U wave (LQT3)
- T-wave alternans in severe cases
- Triggers TdP — polymorphic VT with "twisting" QRS morphology
ECG Image — Long QT Syndrome with Torsades de Pointes:
Panel (a): Prolonged QTc (478 ms) in sinus rhythm. Panel (b): Initiation of Torsades de Pointes — polymorphic VT with twisting QRS morphology around the isoelectric line.
Quick Reference Summary Table
| # | Disease | Key ECG Findings |
|---|---|---|
| 1 | Anterior STEMI | ST elevation V1–V4, reciprocal depression II/III/aVF, Q waves |
| 2 | Inferolateral STEMI | ST elevation II/III/aVF + V4–V6, reciprocal depression I/aVL |
| 3 | Atrial Fibrillation | Absent P waves, fine fibrillatory baseline, irregularly irregular QRS |
| 4 | Ventricular Tachycardia | Wide QRS >120ms, AV dissociation, concordance, rate 100–250 bpm |
| 5 | Complete Heart Block | P waves and QRS fully dissociated, slow escape rhythm |
| 6 | WPW Syndrome | Short PR <120ms, delta wave, wide QRS |
| 7 | Acute Pericarditis | Diffuse saddle ST elevation, PR depression, no reciprocal changes |
| 8 | Pulmonary Embolism | S1Q3T3, sinus tachycardia, T inversions V1–V4, RBBB |
| 9 | HCM | LVH voltage, giant T inversions V3–V5, deep lateral Q waves |
| 10 | LBBB | Wide QRS, notched R (I/aVL/V5–V6), deep S (V1–V3), discordant ST-T |
| +1 | Long QT Syndrome | QTc >440ms, T-wave morphology changes, Torsades de Pointes |
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