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Give me 10 common heart disease with ecg changes and ecg images of that diseases

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ECG changes 10 common heart diseases images examples STEMI atrial fibrillation heart block

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ECG changes heart disease images

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atrial fibrillation ECG image heart block complete ECG image site:litfl.com OR site:ecgwaves.com

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STEMI inferior ECG image pericarditis ECG image ventricular tachycardia ECG image litfl

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atrial fibrillation ECG litfl WPW syndrome ECG ventricular tachycardia ECG left ventricular hypertrophy ECG images

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pulmonary embolism ECG S1Q3T3 right bundle branch block ECG left bundle branch block ECG ventricular tachycardia ECG image litfl

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I now have excellent ECG images and comprehensive information. Let me compile the full answer:

10 Common Heart Diseases with ECG Changes and Images

Here is a quick-reference infographic showing ECG patterns across several killer cardiac conditions:
Killer ECG Patterns - LITFL

1. ST-Elevation Myocardial Infarction (STEMI)

Mechanism: Complete occlusion of a coronary artery causes transmural myocardial ischemia and infarction.
ECG Changes:
  • ST elevation ≥1 mm in 2 or more contiguous leads (≥2 mm in V1-V3)
  • Hyperacute (peaked, broad) T waves - the very earliest sign
  • Development of pathological Q waves (>25% of R wave height, >40ms wide)
  • Reciprocal ST depression in opposite leads
  • T wave inversion in the evolutionary phase
  • Lead localization: Inferior STEMI (II, III, aVF), Anterior STEMI (V1-V4), Lateral STEMI (I, aVL, V5-V6)
ECG Image - Inferior STEMI (massive "tombstone" ST elevations in II, III, aVF):
Inferior STEMI ECG - Tombstone pattern

2. Atrial Fibrillation (AF)

Mechanism: Chaotic, disorganized electrical activity in the atria at 350-600 impulses/min. The AV node blocks most impulses, creating an irregular ventricular response.
ECG Changes:
  • Absent P waves - replaced by irregular fibrillatory baseline (f-waves)
  • Irregularly irregular R-R intervals (the hallmark feature)
  • Narrow QRS complexes (unless aberrant conduction or pre-excitation)
  • Ventricular rate typically 100-180 bpm in uncontrolled AF
ECG Image - AF with irregular rhythm and absent P waves:
Atrial Fibrillation ECG - LITFL

3. Complete Heart Block (3rd Degree AV Block)

Mechanism: Complete failure of AV conduction - no atrial impulses reach the ventricles. The ventricles are driven by a junctional or ventricular escape pacemaker at 20-40 bpm.
ECG Changes:
  • P waves present at normal rate (60-100 bpm) but completely dissociated from QRS complexes
  • Slow, regular ventricular escape rhythm (30-50 bpm)
  • Wide QRS complexes if escape rhythm is ventricular (below Bundle of His)
  • Narrow QRS if junctional escape (above Bundle of His)
  • AV dissociation is the diagnostic hallmark
ECG Image - Complete Heart Block with AV dissociation:
Complete Heart Block ECG - LITFL

4. Acute Pericarditis

Mechanism: Inflammation of the pericardium from viral, bacterial, autoimmune, or idiopathic causes. The inflammatory process affects myocardial repolarization globally.
ECG Changes (classically evolves in 4 stages):
  • Stage 1 (acute): Widespread concave ("saddle-shaped") ST elevation in most leads (I, II, III, aVF, aVL, V2-V6), with PR segment depression - the most characteristic feature
  • Stage 2: Normalization of ST and PR segments
  • Stage 3: T wave inversion (diffuse)
  • Stage 4: Normalization of T waves
  • Notably absent: reciprocal ST depression (unlike STEMI), no Q waves
ECG Image - Pericarditis with saddle-shaped ST elevation and PR depression:
Pericarditis ECG - LITFL

5. Pulmonary Embolism (PE)

Mechanism: Acute right ventricular strain from obstruction of pulmonary vasculature increases RV afterload, causing RV dilatation and altered electrical vectors.
ECG Changes:
  • Sinus tachycardia (most common finding - seen in >50%)
  • S1Q3T3 pattern (McGinn-White sign): S wave in lead I, Q wave and T wave inversion in lead III
  • New right bundle branch block (RBBB) - complete or incomplete
  • Right axis deviation
  • T wave inversions in V1-V4 (right heart strain pattern)
  • Atrial fibrillation or flutter can occur
ECG Image - Massive bilateral PE with sinus tachycardia, S1Q3T3, and right heart strain pattern (T inversions V1-V4):
Pulmonary Embolism ECG - bilateral PE - LITFL

6. Left Bundle Branch Block (LBBB)

Mechanism: Conduction block in the left bundle branch causes abnormal, sequential (right then left) ventricular depolarization producing a broad, notched QRS complex. LBBB is associated with ischemic heart disease, cardiomyopathy, and hypertension. New LBBB should prompt assessment for acute MI (Sgarbossa criteria).
ECG Changes:
  • QRS duration ≥120 ms (broad QRS)
  • Dominant S wave in V1 (rS or QS pattern) - "W" shape
  • Broad, notched ("M-shaped") R wave in V6/I - "M" shape
  • Absence of septal Q waves in I and V6
  • Discordant ST changes (ST/T in opposite direction to QRS)
  • Left axis deviation common
ECG Image - LBBB with classic "W" pattern in V1 and "M" pattern in V6:
LBBB ECG - LITFL

7. Wolff-Parkinson-White Syndrome (WPW)

Mechanism: An accessory pathway (Bundle of Kent) bypasses the AV node, causing early ("pre-excitation") ventricular depolarization. This creates the characteristic delta wave.
ECG Changes (in sinus rhythm):
  • Short PR interval (<120 ms) - AV bypass
  • Delta wave - slurred upstroke of the QRS
  • Wide QRS complex (>120 ms total, due to delta wave + normal conduction)
  • ST-T wave changes discordant to QRS
  • Type A: positive delta and dominant R in V1-V3 (left-sided pathway)
  • Type B: negative delta and QS in V1 (right-sided pathway)
  • During AF: rapid, broad irregular complexes - life-threatening
ECG Image - WPW (Type A) with short PR, delta wave, and wide QRS in sinus rhythm:
WPW Type A ECG - LITFL

8. Left Ventricular Hypertrophy (LVH)

Mechanism: Pressure overload (hypertension, aortic stenosis) or volume overload causes myocardial hypertrophy, increasing the amplitude of electrical vectors from the left ventricle.
ECG Changes:
  • 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 I, aVL, V5-V6
  • Deep S waves in V1-V3
  • Left axis deviation
  • LV "strain" pattern: ST depression and T wave inversion in I, aVL, V5-V6 (secondary repolarization abnormality)
  • Prolonged QRS duration (not as wide as LBBB)
ECG Image showing LVH pattern (tall R waves in lateral leads, deep S waves in right precordial leads, with ST-T strain):
LVH ECG - tall R waves and strain pattern

9. Ventricular Tachycardia (VT)

Mechanism: Three or more consecutive ventricular ectopic beats at a rate >100 bpm, originating below the Bundle of His. Most commonly occurs in the setting of structural heart disease (post-MI scar, cardiomyopathy).
ECG Changes:
  • Broad QRS complexes (≥120 ms) at rate >100 bpm (usually 110-250 bpm)
  • AV dissociation - P waves march through the QRS at a different rate (diagnostic when present)
  • Fusion beats and capture beats (pathognomonic)
  • Concordance: all QRS in precordial leads positive or all negative
  • Brugada criteria and Vereckei algorithm used for VT vs SVT with aberrancy
  • Morphology criteria: northwest axis, QRS >160 ms favors VT

10. Hypertrophic Cardiomyopathy (HCM)

Mechanism: Genetic disorder (most commonly sarcomere protein mutations) causing asymmetric myocardial hypertrophy. The hypertrophied muscle creates abnormal depolarization and repolarization patterns.
ECG Changes (>90% of patients have an abnormal ECG):
  • Left ventricular hypertrophy voltages (giant R waves)
  • Pathological Q waves in inferior (II, III, aVF) and lateral (I, aVL, V5-V6) leads - caused by abnormal septal depolarization ("dagger Q waves")
  • ST depression and T wave inversion in lateral leads
  • Left axis deviation
  • P wave changes (left atrial enlargement)
  • In apical HCM (Yamaguchi variant): giant, symmetric T wave inversions in V3-V5 (up to -20 to -30 mm)
  • Atrial fibrillation can occur as a complication

Quick Summary Table

#ConditionKey ECG Finding
1STEMIST elevation + Q waves in affected leads
2Atrial FibrillationIrregularly irregular rhythm, no P waves
3Complete Heart BlockComplete AV dissociation, slow escape rhythm
4Acute PericarditisWidespread saddle-shaped ST elevation + PR depression
5Pulmonary EmbolismS1Q3T3, sinus tachycardia, RBBB, RV strain T inversions
6LBBBWide QRS, "W" in V1, "M" in V6, discordant ST-T
7WPWShort PR, delta wave, wide QRS
8LVHTall R waves (Sokolow ≥35mm), lateral strain pattern
9Ventricular TachycardiaBroad QRS tachycardia, AV dissociation, fusion beats
10HCMLVH + dagger Q waves in inferior/lateral leads, giant T inversions (apical type)
Sources: LITFL ECG Library, MESI Medical ECG Guide
Clinical note: ECG interpretation should always be correlated with the patient's clinical presentation, history, and other investigations. No single ECG finding is pathognomonic in isolation.
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