Explain me 10 common heart disease with ecg changes and ecg images of those disease
Reading File
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ECG changes myocardial infarction ST elevation
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atrial fibrillation ECG irregular rhythm no P waves
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heart block complete AV block ECG bradycardia
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ventricular tachycardia ECG wide QRS tachycardia
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hypertrophic cardiomyopathy ECG left ventricular hypertrophy deep S wave
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pericarditis ECG saddle shape ST elevation diffuse PR depression
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Wolff-Parkinson-White syndrome ECG delta wave short PR interval
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dilated cardiomyopathy ECG left bundle branch block low voltage
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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia
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heart failure ECG left ventricular hypertrophy strain pattern ST depression T wave inversion
Here is a comprehensive guide to 10 common heart diseases with their characteristic ECG changes and illustrative ECG images.
10 Common Heart Diseases: ECG Changes & Images
1. 🫀 ST-Elevation Myocardial Infarction (STEMI)
ECG Changes
- Hyperacute T waves (earliest sign — tall, peaked, symmetric T waves)
- ST-segment elevation ≥ 1 mm in ≥ 2 contiguous leads (convex/"tombstone" morphology)
- Reciprocal ST depression in opposite leads
- Pathological Q waves (> 40 ms wide, > 25% of R-wave height) — indicate completed infarction
- T-wave inversion in the evolutionary phase
| Territory | Leads with ST Elevation | Culprit Artery |
|---|---|---|
| Anterior | V1–V4 | LAD (proximal) |
| Lateral | I, aVL, V5–V6 | LCx or diagonal |
| Inferior | II, III, aVF | RCA or LCx |
| Posterior | Dominant R in V1–V2, ST depression | RCA or LCx |
ECG Image — Anterior STEMI (LAD occlusion)
Acute anterolateral STEMI: ST elevation V1–V6 with hyperacute T waves and reciprocal inferior ST depression. Consistent with proximal LAD occlusion.
ECG Image — Inferior + Posterior STEMI
ST elevation in II, III, aVF (inferior); prominent R waves + ST depression V1–V3 (posterior). Likely RCA or LCx occlusion.
2. 💓 Atrial Fibrillation (AF)
ECG Changes
- Absent P waves — replaced by chaotic fibrillatory (f) waves (best seen in V1)
- Irregularly irregular RR intervals — the hallmark
- Narrow QRS complexes (unless aberrant conduction/bundle branch block)
- Ventricular rate varies: controlled (60–100 bpm), rapid (> 100 bpm), or slow (< 60 bpm)
- Fine f waves (< 1 mm) vs. coarse f waves (> 1 mm)
ECG Image — Atrial Fibrillation
Classic AF: absent P waves replaced by fine f waves, irregularly irregular RR intervals, narrow QRS complexes.
3. 🔋 Complete (Third-Degree) AV Block
ECG Changes
- Complete AV dissociation — P waves and QRS complexes fire independently
- Atrial rate > ventricular rate
- No fixed PR interval — P waves "march through" QRS without relation
- Escape rhythm: narrow QRS (junctional, ~40–60 bpm) or wide QRS (ventricular, ~20–40 bpm)
- Wide QRS escape = infra-nodal block (worse prognosis)
| Block Level | QRS Width | Escape Rate |
|---|---|---|
| AV node | Narrow | 40–60 bpm |
| Bundle of His | Narrow/wide | 40–60 bpm |
| Bundle branches | Wide (RBBB/LBBB) | 20–40 bpm |
ECG Image — Complete Heart Block
Third-degree AV block: P waves (arrows) march independently of wide RBBB-pattern escape QRS complexes. Ventricular rate ~33 bpm.
4. ⚡ Ventricular Tachycardia (VT)
ECG Changes
- Wide complex tachycardia — QRS > 120 ms (often > 160 ms)
- Rate usually 100–250 bpm, regular rhythm
- AV dissociation — P waves independent of QRS (when visible)
- Fusion beats and capture beats (pathognomonic)
- Concordance in precordial leads (positive or negative)
- Axis: northwest axis (negative in I, II, III, aVF) strongly suggests VT
ECG Image — Monomorphic VT
Wide-complex tachycardia with positive concordance (V1–V6 all positive), superior axis, and no visible P waves — classic monomorphic VT.
5. 🔥 Acute Pericarditis
ECG Changes (4 evolutionary stages)
| Stage | Timing | ECG Finding |
|---|---|---|
| I | Days 1–2 | Diffuse concave ST elevation + PR depression |
| II | Days 3–7 | ST returns to baseline, T-waves flatten |
| III | Week 2 | T-wave inversions |
| IV | Weeks–months | ECG normalizes |
- Diffuse ST elevation (I, II, III, aVF, V2–V6) — saddle-shaped/concave morphology
- PR depression in most leads, PR elevation in aVR (highly specific)
- Spodick's sign — downsloping TP segment
- No reciprocal changes (unlike STEMI) — aVR is the only reciprocal lead
ECG Image — Acute Pericarditis
Acute pericarditis: diffuse concave "saddle-shaped" ST elevation in I, II, III, aVF, V2–V6; PR depression in II; reciprocal ST depression and PR elevation in aVR; Spodick's sign visible.
6. 🩺 Wolff-Parkinson-White Syndrome (WPW)
ECG Changes
- Short PR interval (< 120 ms) — accessory pathway bypasses AV node delay
- Delta wave — slurred upstroke at the start of QRS (pre-excitation)
- Widened QRS complex (> 120 ms) due to fusion of conducted + pre-excited beats
- Secondary ST-T changes — discordant (opposite to delta wave direction)
- Pseudo-infarction pattern — negative delta waves in inferior leads mimic Q waves
Pathway location can be localized by delta wave polarity across leads.
ECG Image — WPW Syndrome
Classic WPW triad: shortened PR interval (< 120 ms), delta waves (slurred QRS upstroke) prominent in II, III, aVF and V2–V6, and widened QRS.
7. 🏋️ Hypertrophic Cardiomyopathy (HCM)
ECG Changes
- Left ventricular hypertrophy voltage criteria (Sokolow-Lyon: S in V1 + R in V5/V6 > 35 mm)
- "Giant" deep symmetric T-wave inversions — classic in apical HCM (Yamaguchi variant), especially V3–V5
- Strain pattern — ST depression + asymmetric T-wave inversion in lateral leads (V4–V6, I, aVL)
- Absence of septal Q waves in lateral leads (I, aVL, V5, V6) — due to abnormal septal activation
- Abnormal Q waves in inferior/lateral leads — mimic ischemia
- Left axis deviation common
ECG Image — Hypertrophic Cardiomyopathy
Apical HCM (Yamaguchi syndrome): high LVH voltage with deep symmetric "giant" T-wave inversions across V2–V6 and limb leads — a hallmark of this variant.
8. 💨 Pulmonary Embolism (PE)
ECG Changes
- Sinus tachycardia — most common (present in ~40% of PE)
- S1Q3T3 pattern — S wave in lead I, Q wave + T-wave inversion in lead III (classic, but only 20% sensitive)
- Incomplete or complete RBBB — due to acute right ventricular dilation
- T-wave inversions in V1–V4 (right ventricular strain pattern)
- P pulmonale — tall P waves in II (> 2.5 mm) — right atrial enlargement
- Right axis deviation
- Atrial fibrillation or flutter may occur
ECG Image — Pulmonary Embolism (S1Q3T3)
Acute PE: sinus tachycardia at 116 bpm, S1Q3T3 pattern (S wave in I, Q wave + T inversion in III), T-wave inversions V1–V3 indicating RV strain, and incomplete RBBB.
9. 🫁 Heart Failure with LV Hypertrophy (Hypertensive Heart Disease)
ECG Changes
- LVH voltage criteria met:
- Sokolow-Lyon: S(V1) + R(V5 or V6) ≥ 35 mm
- Cornell: R(aVL) + S(V3) > 28 mm (men), > 20 mm (women)
- "Strain pattern" — downsloping ST depression + asymmetric T-wave inversion in lateral leads (I, aVL, V4–V6)
- Left atrial enlargement — bifid P wave (P mitrale) in II, negative terminal P in V1
- Left axis deviation (common)
- Non-specific intraventricular conduction delay or LBBB in advanced disease
ECG Image — LVH with Strain Pattern
LVH with strain: tall R waves in lateral leads (V5–V6), deep S waves in V1–V2 (meeting Sokolow-Lyon criteria), ST depression and T-wave inversions in II, III, aVF, V5–V6 — classic "strain pattern."
10. 🔵 Dilated Cardiomyopathy (DCM)
ECG Changes
- Left bundle branch block (LBBB) — very common (broad, notched R in I, aVL, V5–V6; QS in V1–V3)
- Low voltage in limb leads (< 5 mm) — from myocardial fibrosis/fat
- Sinus tachycardia — compensatory
- Left axis deviation
- LVH voltage criteria may be met
- Fragmented QRS — notching/slurring within QRS, indicates fibrosis
- Non-specific ST-T changes widespread
- Atrial fibrillation — common arrhythmic complication
- Frequent PVCs or ventricular tachycardia
ECG Image — DCM with LBBB
DCM after septal myectomy: top tracing shows high LVH voltage (pre-op); bottom shows development of classic LBBB — broad notched R in lateral leads, QS in V1–V3, discordant ST-T changes.
Summary Table
| # | Disease | Key ECG Findings | Key Lead(s) |
|---|---|---|---|
| 1 | STEMI | Convex ST elevation → Q waves → T inversion | Territory-specific |
| 2 | Atrial Fibrillation | Absent P waves, irregular RR intervals | All leads, V1 |
| 3 | Complete AV Block | AV dissociation, slow escape rhythm | All leads |
| 4 | Ventricular Tachycardia | Wide QRS tachycardia, AV dissociation | All leads |
| 5 | Acute Pericarditis | Diffuse concave ST ↑, PR depression | I, II, V2–V6 |
| 6 | WPW Syndrome | Short PR, delta wave, wide QRS | All leads |
| 7 | HCM | Giant T inversions, LVH, no septal Q | V3–V6, I, aVL |
| 8 | Pulmonary Embolism | S1Q3T3, RBBB, RV strain T inversions | I, III, V1–V4 |
| 9 | Hypertensive Heart Disease | LVH voltage + strain pattern | V1–V6, I, aVL |
| 10 | Dilated Cardiomyopathy | LBBB, low voltage, fragmented QRS | V1–V6, I, aVL |
Clinical Pearl: ECG changes must always be interpreted alongside the clinical context. A single ECG pattern (e.g., ST elevation) can appear in multiple conditions — the distribution, morphology, and associated findings guide the correct diagnosis.
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