Top 10 ecg disease findgs

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ECG findings disease patterns electrocardiogram

Finding Sources

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STEMI ST elevation myocardial infarction ECG pattern

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atrial fibrillation ECG irregular rhythm no P waves

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Wolff-Parkinson-White delta wave ECG short PR interval

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pulmonary embolism S1Q3T3 right heart strain ECG

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complete heart block third degree AV block ECG P waves dissociated QRS

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Brugada syndrome coved ST elevation V1 V2 right bundle branch block ECG

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hyperkalemia peaked T waves ECG sine wave pattern

I now have excellent images and content for all 10 major ECG findings. Here is the comprehensive guide:

Top 10 ECG Disease Findings

1. 🫀 STEMI — ST-Elevation Myocardial Infarction

Key ECG features:

ST elevation ≥1 mm in ≥2 contiguous leads
Convex (coved/tombstone) upward ST morphology
Reciprocal ST depression in opposite leads
Later: Q waves >0.04 s, T-wave inversions

Territories:

Territory	Leads with STE	Culprit Artery
Anterior	V1–V4	LAD
Inferior	II, III, aVF	RCA
Lateral	I, aVL, V5–V6	LCx
Posterior	V1–V3 depression (mirror)	RCA/LCx

Anterolateral STEMI with ST elevation V1-V6 and reciprocal inferior depression

Inferior STEMI with convex ST elevation in II, III, aVF and reciprocal depression laterally

2. 🌀 Atrial Fibrillation (AF)

Key ECG features:

Irregularly irregular R-R intervals (no pattern)
Absent P waves — replaced by fine fibrillatory (f) waves, best seen in V1 and II
Narrow QRS (unless aberrant conduction)
Ventricular rate varies (60–170+ bpm if uncontrolled)

AF showing irregularly irregular rhythm, absent P waves, fine fibrillatory waves in V1

3. ⚡ Complete (3rd-Degree) AV Block

Key ECG features:

Complete AV dissociation — P waves and QRS complexes are totally independent
P waves march at their own rate (faster); QRS at a slower escape rate
Wide QRS if ventricular escape (infra-nodal); narrow QRS if junctional escape
Profound bradycardia; requires urgent pacing

Third-degree AV block with P waves dissociated from QRS complexes, wide ventricular escape

4. 🔥 Brugada Syndrome

Key ECG features:

Type 1 (diagnostic): Coved ST elevation ≥2 mm in V1–V2, descending into inverted T-wave — no isoelectric segment
Incomplete or complete RBBB morphology in V1–V2
Occurs spontaneously or unmasked by Na⁺-channel blockers (ajmaline, flecainide)
Risk of sudden cardiac death from VF

Brugada Type 1 coved ST elevation in V1-V2 with inverted T-wave

5. 🌪️ Pulmonary Embolism (PE)

Key ECG features:

Sinus tachycardia (most common finding)
S1Q3T3 pattern: Deep S in lead I + Q wave in III + T-wave inversion in III
Right heart strain: T-wave inversions V1–V4, incomplete RBBB
Right axis deviation
New RBBB

PE showing S1Q3T3 pattern — S wave in lead I, Q wave in III, T-wave inversion in III

6. ⚠️ Hyperkalemia

Key ECG features (progression with rising K⁺):

K⁺ Level	ECG Finding
5.5–6.5 mEq/L	Tall, peaked (tented), narrow-based T waves
6.5–7.5 mEq/L	PR prolongation, P-wave flattening/disappearance
7.5–8.0 mEq/L	QRS widening, bundle branch block patterns
>8.0 mEq/L	Sine-wave pattern, VF/asystole risk

Hyperkalemia showing peaked tented T waves in precordial leads

7. 🏔️ Wolff-Parkinson-White (WPW) Syndrome

Key ECG features (classic triad):

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 from delta)
Risk: AF with rapid conduction → VF (avoid AV nodal blockers)

Localizing the accessory pathway: dominant R in V1 = left-sided pathway; negative delta in inferior leads = posteroseptal

WPW showing short PR, delta waves, widened QRS with pre-excitation

8. 🫁 Pericarditis

Key ECG features (evolve through 4 stages):

Stage 1: Diffuse saddle-shaped (concave up) ST elevation in most leads (except aVR, V1); PR segment depression (most sensitive sign)
Stage 2: ST normalizes, T waves flatten
Stage 3: Diffuse T-wave inversions
Stage 4: ECG normalizes
Electrical alternans when pericardial effusion present → consider tamponade

9. 📈 Left Ventricular Hypertrophy (LVH)

Key ECG features:

Sokolow-Lyon criterion: S in V1 + R in V5 or V6 ≥35 mm
Cornell criterion: R in aVL + S in V3 >28 mm (men) / >20 mm (women)
LV strain pattern: ST depression + T-wave inversion in lateral leads (I, aVL, V5–V6)
Left axis deviation
Associated with HTN, aortic stenosis, HCM

10. 🌊 Ventricular Tachycardia (VT)

Key ECG features:

Wide complex tachycardia (QRS ≥120 ms) at rate >100 bpm
AV dissociation (independent P waves) — pathognomonic
Fusion beats and capture beats — confirm VT
Concordance in precordial leads (all positive or all negative)
Brugada criteria and Vereckei criteria help differentiate from SVT with aberrancy

Feature	Favors VT	Favors SVT + Aberrancy
QRS width	>140 ms (RBBB), >160 ms (LBBB)	Narrower
Axis	Extreme right or NW (−90 to ±180°)	Normal/left
AV dissociation	Present	Absent
Precordial concordance	Present	Absent

Quick Reference Summary

#	Condition	Hallmark ECG Sign
1	STEMI	ST elevation + reciprocal depression in contiguous leads
2	Atrial Fibrillation	Irregularly irregular, no P waves
3	3rd-Degree AV Block	Complete P-QRS dissociation
4	Brugada Syndrome	Coved ST elevation V1–V2
5	Pulmonary Embolism	S1Q3T3 + RV strain
6	Hyperkalemia	Peaked T waves → sine wave
7	WPW	Short PR + delta wave + wide QRS
8	Pericarditis	Diffuse saddle ST elevation + PR depression
9	LVH	High voltage + lateral strain pattern
10	Ventricular Tachycardia	Wide complex tachycardia + AV dissociation

Sources: ROSEN's Emergency Medicine; Harrison's Principles of Internal Medicine 22E; Tintinalli's Emergency Medicine; Goldman-Cecil Medicine — ECG findings sections

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