Give me 10 common heart disease ECG changes and ECG image of those

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ECG changes heart disease STEMI LBBB atrial fibrillation VT LVH example images

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STEMI ECG ST elevation myocardial infarction example ECG image site:litfl.com OR site:ecgwaves.com

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atrial fibrillation ventricular tachycardia LVH prolonged QT bundle branch block ECG images litfl.com

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LVH left ventricular hypertrophy ECG prolonged QT RBBB right bundle branch block pathological Q waves ECG strip image

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T wave inversion ECG ischemia first degree AV block complete heart block Wolff-Parkinson-White ECG strip images site:litfl.com

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I now have all the images and content needed. Here is the complete guide:

10 Common Heart Disease ECG Changes

1. ST-Segment Elevation (STEMI)

Condition: Acute ST-Elevation Myocardial Infarction

ECG Features:

ST elevation ≥1 mm in ≥2 contiguous limb leads, or ≥2 mm in ≥2 contiguous precordial leads
Reciprocal ST depression in mirror-image leads
Hyperacute (tall, peaked) T waves in the very early phase
Q waves develop within hours and persist as a scar marker
New LBBB in the context of chest pain is treated as a STEMI-equivalent

Evolution of ECG changes from Normal → Hyperacute → Acute → Hours → Days → Weeks:

Frameworks for Internal Medicine - Figure 2-2. ECG evolution in STEMI (from Lilly, Pathophysiology of Heart Disease, 6th ed.)

2. ST-Segment Depression / T-Wave Inversion (NSTEMI / UA)

Condition: Non-ST Elevation Myocardial Infarction / Unstable Angina / Subendocardial Ischemia

ECG Features:

New horizontal or downsloping ST depression ≥0.05 mV in ≥2 contiguous leads
T-wave inversion ≥0.1 mV in ≥2 contiguous leads with prominent R wave or R/S >1
No Q waves (non-transmural injury)
ECG may be normal in UA

Frameworks for Internal Medicine - Figure 2-3. ECG abnormalities in UA/NSTEMI (from Lilly, Pathophysiology of Heart Disease, 6th ed.)

3. Pathological Q Waves (Old / Completed MI)

Condition: Prior (completed) myocardial infarction

ECG Features:

Q wave duration ≥0.04 sec (≥1 small square)
Q wave depth ≥25% of the following R wave height
Present in the territory of infarction (inferior: II, III, aVF; anterior: V1-V4; lateral: I, aVL, V5-V6)
Q waves persist as a permanent scar marker weeks to years after MI

(See the "Weeks later" panel in Figure 2-2 above - Q wave persists with normalized ST and T)

4. Atrial Fibrillation (AF)

Condition: Most common sustained arrhythmia; associated with hypertensive heart disease, valvular disease, heart failure, ischemic heart disease

ECG Features:

Absent P waves - replaced by chaotic fibrillatory baseline (f-waves)
Irregularly irregular ventricular rate
Narrow QRS complexes (unless aberrant conduction/BBB)
Ventricular rate 100-160 bpm if uncontrolled

Atrial fibrillation ECG - irregularly irregular rhythm with no P waves

ECGGuru - Atrial fibrillation with rate-related changes. Note the completely irregular rhythm and absent P waves.

5. Left Bundle Branch Block (LBBB)

Condition: Ischemic heart disease, cardiomyopathy, valvular disease, hypertension; new LBBB in chest pain = STEMI-equivalent

ECG Features:

QRS duration ≥120 ms (≥3 small squares)
V1: 'M'-shaped (RSR') or broad monophasic S wave
V6: 'W' pattern - broad notched R wave
Absent septal Q waves in lateral leads (I, aVL, V5-V6)
Secondary ST/T wave changes opposite to main QRS deflection (discordance)

LBBB ECG - V1 shows 'M' pattern, V6 shows 'W' pattern

The LBBB signature pattern - V1 = 'M' shape, V6 = 'W' shape (opposite of RBBB):

(V1 'M' and V6 'W' are the hallmark - see the diagnostic diagram below for RBBB comparison)

6. Right Bundle Branch Block (RBBB)

Condition: Right heart strain (PE, pulmonary hypertension), ischemic heart disease, congenital heart disease; can be a normal variant

ECG Features:

QRS duration ≥120 ms
V1: RSR' ('rabbit ears') - broad 'M'-shaped complex
V6: Wide slurred S wave ('W' pattern)
T-wave inversion in V1-V3 (appropriate discordance)
Anterior ST depression may accompany

RBBB ECG strip - RSR' in V1 (M pattern) and wide S in V6 (W pattern)

LITFL ECG Library - RBBB: RSR' in V1 ('M' pattern) and slurred S in V6 ('W' pattern). T-wave inversion V1-V3.

7. Ventricular Tachycardia (VT)

Condition: Ischemic cardiomyopathy, dilated cardiomyopathy, post-MI scar, channelopathies (e.g., Brugada, Long QT)

ECG Features:

Rate >100 bpm (typically 120-250 bpm)
Wide QRS complexes ≥120 ms with bizarre morphology
AV dissociation (P waves independent of QRS) - pathognomonic
Fusion beats and capture beats (if present, confirm VT diagnosis)
Concordance in precordial leads (all positive or all negative V1-V6)

Ventricular tachycardia - wide complex tachycardia at 157 bpm

ECGGuru - Ventricular tachycardia at 157 bpm. Note the wide, bizarre QRS morphology and rapid rate.

8. Left Ventricular Hypertrophy (LVH)

Condition: Hypertensive heart disease, aortic stenosis, hypertrophic cardiomyopathy

ECG Features:

Sokolow-Lyon criteria: S in V1 + R in V5 or V6 ≥35 mm
Cornell criteria: R in aVL + S in V3 >28 mm (men), >20 mm (women)
Tall R waves in lateral leads (I, aVL, V5-V6)
Deep S waves in right precordial leads (V1-V2)
Secondary ST depression and T-wave inversion in lateral leads ("strain pattern")
Left axis deviation

LVH ECG showing tall R waves and ST strain pattern in lateral leads

LITFL ECG Library - LVH with typical lateral strain pattern. Note the tall R waves in lateral leads and ST/T changes that can mimic ischemia.

9. Prolonged QT Interval

Condition: Congenital Long QT syndrome, drug-induced (antiarrhythmics, antipsychotics, antibiotics), electrolyte disturbances (hypokalemia, hypomagnesemia, hypocalcemia), myocarditis

ECG Features:

Corrected QT interval (QTc) >440 ms in men, >460 ms in women
Risk of Torsades de Pointes (polymorphic VT) when QTc >500 ms
Broad, notched T waves; U waves may be prominent
Measured from start of QRS to end of T wave

(Refer to the Atrial Fibrillation ECG above - note the measured QTc 445 ms shown at top of that tracing, just above borderline prolonged)

10. AV Blocks (First, Second, and Complete/Third Degree)

Condition: Ischemic heart disease (inferior MI often causes AV block via right coronary artery involvement), drugs (digoxin, beta-blockers, calcium channel blockers), infiltrative diseases (sarcoidosis, amyloidosis), Lyme disease

ECG Features by Degree:

Degree	PR Interval	QRS Dropped?	Key Finding
1st degree	>200 ms (>5 small squares)	No	Every P conducts, just slowly
2nd degree Mobitz I (Wenckebach)	Progressively lengthens	Yes, cyclically	Progressive PR lengthening then dropped beat
2nd degree Mobitz II	Constant	Yes, suddenly	Fixed PR then sudden dropped QRS - more dangerous
3rd degree (complete)	No relationship	Every QRS is escape	AV dissociation - P and QRS completely independent

AV block degrees ECG comparison showing all 4 patterns

Comparison of all AV block degrees: 1st degree (prolonged PR), 2nd degree Mobitz I (progressive PR then dropped beat), 2nd degree Mobitz II (sudden dropped QRS), and 3rd degree complete heart block (full AV dissociation).

Quick Reference Summary

#	Finding	Key Feature	Associated Condition
1	ST elevation	≥1-2 mm elevation in contiguous leads	STEMI, acute MI
2	ST depression / T inversion	Horizontal/downsloping depression	NSTEMI, ischemia
3	Pathological Q waves	≥0.04 s wide, ≥25% of R	Prior MI (scar)
4	Atrial fibrillation	Irregular rhythm, no P waves	HTN, valvular, HF
5	LBBB	QRS ≥120 ms, V1='M', V6='W'	IHD, cardiomyopathy
6	RBBB	QRS ≥120 ms, V1 RSR', wide S in V6	PE, IHD, normal variant
7	Ventricular tachycardia	Wide QRS >100 bpm, AV dissociation	Cardiomyopathy, post-MI
8	LVH	S(V1) + R(V5/V6) ≥35 mm, strain pattern	Hypertension, AS
9	Prolonged QT	QTc >440/460 ms	Drugs, electrolytes, congenital
10	AV block	PR prolonged / dropped QRS / AV dissociation	IHD, drugs, infiltrative

Sources: Frameworks for Internal Medicine (Wolters Kluwer), Harrison's Principles of Internal Medicine 22E, LITFL ECG Library, ECGGuru

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