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ECG electrocardiogram patterns heart disease

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myocardial infarction STEMI ECG ST elevation

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atrial fibrillation ECG irregular rhythm

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complete heart block third degree AV block ECG

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ventricular tachycardia ECG wide QRS

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Wolff-Parkinson-White syndrome ECG delta wave

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left bundle branch block LBBB ECG broad QRS

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pulmonary embolism ECG S1Q3T3 right heart strain

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hypertrophic cardiomyopathy ECG deep Q waves LVH

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long QT syndrome ECG prolonged QT interval torsades

I now have excellent images for all 10 conditions. Here is a comprehensive guide to 10 Heart Disease ECG Patterns with real clinical images:

10 Heart Disease ECG Patterns

1. 🫀 STEMI (ST-Elevation Myocardial Infarction)

Key ECG Features:

Convex ("tombstone") ST elevation ≥ 1 mm in ≥ 2 contiguous leads
Hyperacute (peaked) T waves in early phase
Reciprocal ST depression in opposing leads
Q waves develop as infarction evolves

Localisation: V1–V4 = anterior (LAD); II, III, aVF = inferior (RCA); I, aVL, V5–V6 = lateral (LCx)

STEMI - Anterior Wall, Tombstone Pattern

Anterior STEMI: Convex ST elevation V2–V5 (tombstone morphology), reciprocal depression in inferior leads

2. 💓 Atrial Fibrillation (AF)

Key ECG Features:

Irregularly irregular RR intervals — the hallmark
Absent P waves; replaced by chaotic fibrillatory (f) waves, best seen in V1 and II
Narrow QRS complexes (unless aberrant conduction)
Ventricular rate varies (controlled < 100 bpm; uncontrolled ≥ 100 bpm)

Atrial Fibrillation - Irregularly Irregular Rhythm

Classic AF: No organized P waves, irregularly irregular QRS intervals, fine fibrillatory baseline

3. 🚫 Complete (3rd Degree) AV Block

Key ECG Features:

Complete AV dissociation — P waves and QRS complexes march independently
Atrial rate faster than ventricular escape rate
Escape QRS can be narrow (junctional, ~40–60 bpm) or wide (ventricular, ~20–40 bpm)
Regular PP intervals and regular RR intervals, but NO fixed PR relationship

Complete AV block: P waves march through QRS complexes with no relationship; slow wide ventricular escape rhythm

4. ⚡ Ventricular Tachycardia (VT)

Key ECG Features:

Wide QRS tachycardia (QRS > 120 ms) at rate > 100 bpm
Regular, monomorphic (uniform) QRS morphology
No visible P waves (or AV dissociation present)
Fusion beats and capture beats are pathognomonic when seen
Positive or negative concordance across precordial leads

Monomorphic Ventricular Tachycardia - Wide Complex

VT: Wide QRS tachycardia, positive precordial concordance, superior axis, no visible P waves

5. 🔵 Wolff-Parkinson-White (WPW) Syndrome

Key ECG Features:

Short PR interval (< 120 ms)
Delta wave — slurred upstroke at start of QRS
Wide QRS (> 120 ms) due to pre-excitation
Secondary ST/T changes (discordant to delta wave direction)
Pathway location can be inferred from delta wave polarity

Wolff-Parkinson-White Syndrome - Delta Wave Pre-excitation

WPW: Short PR, prominent delta waves in V3–V6 and inferior leads, widened QRS — left anterolateral accessory pathway

6. 🟣 Left Bundle Branch Block (LBBB)

Key ECG Features:

QRS > 120 ms
Broad monophasic R wave in I, aVL, V5, V6 (often notched/"M-shaped")
Deep QS or rS in V1–V3
No septal Q waves in lateral leads
Secondary (discordant) ST/T changes — ST elevation in V1–V3, ST depression/T inversion in V5–V6

New LBBB in acute chest pain = treat as STEMI equivalent!

Left Bundle Branch Block - Classic LBBB Pattern

LBBB: Broad monophasic R in lateral leads, deep S/QS in V1–V3, discordant ST-T changes

7. 🫁 Pulmonary Embolism (PE) — Right Heart Strain

Key ECG Features:

S1Q3T3 pattern: prominent S in lead I, Q wave in III, T inversion in III
Sinus tachycardia (most common finding)
T-wave inversions in V1–V4 (right ventricular strain)
Incomplete or complete RBBB
Right axis deviation

Pulmonary Embolism - S1Q3T3 Right Heart Strain

Acute PE: Classic S1Q3T3 pattern annotated with circles — S wave in I, Q wave in III, T-wave inversion in III

8. 🧱 Hypertrophic Cardiomyopathy (HCM)

Key ECG Features:

High QRS voltage (LVH by Sokolow-Lyon: SV1 + RV5 > 35 mm)
Giant symmetric T-wave inversions in precordial leads (especially apical HCM, Yamaguchi syndrome — V3–V5)
Deep narrow Q waves in lateral/inferior leads (septal hypertrophy)
Left axis deviation
Often AF or other arrhythmias

Hypertrophic Cardiomyopathy - Apical HCM Giant T-wave inversions

Apical HCM: High LVH voltage + giant deep symmetric T-wave inversions in V3–V5 — classic Yamaguchi pattern

9. ⏱️ Long QT Syndrome (LQTS)

Key ECG Features:

Prolonged QTc (> 440 ms men, > 460 ms women; > 500 ms = high risk)
T-wave alternans (beat-to-beat variation in T-wave amplitude) — marker of instability
Different T-wave morphologies by subtype: LQT1 = broad-based T; LQT2 = notched T; LQT3 = late-onset T with long flat ST
Can degenerate into Torsades de Pointes (TdP) → polymorphic VT

Long QT Syndrome with Torsades de Pointes

LQTS: Markedly prolonged QTc (478 ms) in Panel a; Panel b shows degeneration into Torsades de Pointes — classic "twisting" polymorphic VT

10. 🌊 Wellens' Syndrome (Critical LAD Stenosis)

Key ECG Features:

Type A: Biphasic T waves (positive-negative) in V2–V3
Type B: Deep symmetric T-wave inversions in V2–V3 (more common, ~75%)
Minimal or no ST elevation
Normal or minimally elevated troponin at presentation
Represents critical proximal LAD stenosis — imminent anterior STEMI if untreated
Do NOT perform stress test — risk of precipitating massive MI!

Wellens' Syndrome Type A - Biphasic T waves LAD Stenosis

Wellens' Syndrome Type A: Biphasic T waves in V2–V3, deep symmetric inversions in V4–V5 — proximal LAD critical stenosis, requires urgent catheterization

Quick Reference Summary

#	Condition	Key ECG Finding
1	STEMI	Convex ST elevation + reciprocal changes
2	Atrial Fibrillation	Irregularly irregular, no P waves
3	3rd Degree AV Block	Complete AV dissociation, slow escape
4	Ventricular Tachycardia	Wide QRS tachycardia, no P waves
5	WPW Syndrome	Short PR + delta wave + wide QRS
6	LBBB	Wide QRS, broad R in V5–V6, QS in V1
7	Pulmonary Embolism	S1Q3T3, RV strain, sinus tachycardia
8	HCM	LVH voltage + giant T-wave inversions
9	Long QT Syndrome	Prolonged QTc → Torsades de Pointes
10	Wellens' Syndrome	Biphasic/deep T inversions V2–V3 (LAD warning)

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