explain 10 common heart diseases with ecg changes and ecg images of those diseases
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myocardial infarction STEMI ECG ST elevation changes
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atrial fibrillation ECG electrocardiogram
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heart block complete AV block third degree ECG
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ventricular tachycardia VT ECG wide complex tachycardia
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left ventricular hypertrophy ECG high voltage criteria
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pericarditis ECG saddle-shaped ST elevation diffuse
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Wolff-Parkinson-White WPW syndrome ECG delta wave pre-excitation
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right bundle branch block RBBB ECG RSR pattern V1
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dilated cardiomyopathy heart failure ECG changes
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pulmonary embolism PE ECG S1Q3T3 right heart strain
Here is a comprehensive guide to 10 common heart diseases with their ECG changes and images:
10 Common Heart Diseases: ECG Changes & Images
1. 🫀 ST-Elevation Myocardial Infarction (STEMI)
Overview
Complete occlusion of a coronary artery causing transmural (full-thickness) myocardial necrosis.
ECG Changes
| Feature | Description |
|---|---|
| ST elevation | Convex ("tombstone") ST elevation ≥1 mm in ≥2 contiguous leads |
| Reciprocal ST depression | In leads facing the opposite wall |
| Hyperacute T-waves | Tall, peaked T-waves in early phase |
| Pathological Q-waves | Develop within hours (>40 ms wide, >25% of R-wave amplitude) |
| T-wave inversion | Late/evolving change |
Localization
- Anterior (LAD): ST ↑ in V1–V4
- Inferior (RCA): ST ↑ in II, III, aVF
- Lateral (LCx): ST ↑ in I, aVL, V5–V6
ECG Images
Anterior STEMI (LAD occlusion) — "tombstoning" in V2–V4:
Inferior STEMI (RCA occlusion) — ST elevation in II, III, aVF with reciprocal depression in I, aVL:
2. 🫀 Atrial Fibrillation (AF)
Overview
Chaotic, disorganized atrial electrical activity causing an irregular ventricular response. Most common sustained arrhythmia, affecting ~2% of the population.
ECG Changes
| Feature | Description |
|---|---|
| No P-waves | Replaced by fine irregular fibrillatory (f) waves |
| Irregularly irregular rhythm | No two R-R intervals are the same |
| Narrow QRS | Unless aberrant conduction or bundle branch block coexists |
| Variable ventricular rate | Typically 100–160 bpm in uncontrolled AF |
ECG Image
Atrial Fibrillation — no P-waves, irregular R-R intervals, fine f-waves in V1:
3. 🫀 Complete (Third-Degree) Heart Block
Overview
Total failure of conduction between atria and ventricles through the AV node. Atria and ventricles beat independently.
ECG Changes
| Feature | Description |
|---|---|
| AV dissociation | P-waves march through QRS complexes with no fixed PR interval |
| Regular P-P intervals | Normal atrial rate (60–100 bpm) |
| Slow escape rhythm | Ventricular rate 20–40 bpm (junctional) or 30–40 bpm (ventricular) |
| Wide QRS | >120 ms if ventricular escape; narrow if junctional escape |
ECG Image
Complete Heart Block — independent P-waves marching through wide QRS complexes:
4. 🫀 Ventricular Tachycardia (VT)
Overview
Three or more consecutive ventricular beats at >100 bpm originating below the bundle of His. A life-threatening arrhythmia requiring immediate management.
ECG Changes
| Feature | Description |
|---|---|
| Wide QRS | >120 ms (typically >140 ms) |
| Regular, rapid rhythm | 100–250 bpm |
| AV dissociation | P-waves independent of QRS (pathognomonic) |
| Fusion/capture beats | Intermittent narrow QRS = sinus capture (confirms VT) |
| Concordance | All precordial leads positive or all negative |
| No preceding P-waves | Ectopic ventricular origin |
ECG Image
Monomorphic VT — wide QRS tachycardia at ~150 bpm with capture beat (circled):
5. 🫀 Acute Pericarditis
Overview
Inflammation of the pericardial sac, often viral in origin. Produces characteristic widespread ECG changes across four evolutionary stages.
ECG Changes (4 Stages)
| Stage | Timing | ECG Feature |
|---|---|---|
| Stage 1 | Hours–days | Diffuse concave ("saddle-shaped") ST elevation + PR depression |
| Stage 2 | Days 1–3 | ST normalizes, PR depression persists |
| Stage 3 | Days 3–7 | Diffuse T-wave inversion |
| Stage 4 | Weeks | ECG normalizes |
Key distinguishing features from STEMI:
- ST elevation is diffuse (not localized to one territory)
- PR segment depression in II, V4–V6 (and PR elevation in aVR)
- No reciprocal ST depression
- Spodick's sign: downsloping TP segment
ECG Image
Acute Pericarditis — diffuse saddle-shaped ST elevation with PR depression:
6. 🫀 Left Ventricular Hypertrophy (LVH)
Overview
Thickening of the left ventricular wall, most commonly from chronic hypertension or aortic stenosis. The increased muscle mass generates larger electrical voltages.
ECG Changes
| Feature | Description |
|---|---|
| Sokolow-Lyon criteria | S in V1 + R in V5 or V6 ≥35 mm |
| Cornell criteria | R in aVL + S in V3 >28 mm (men) or >20 mm (women) |
| Left axis deviation | QRS axis between −30° and −90° |
| Strain pattern | ST depression + T-wave inversion in I, aVL, V5–V6 |
| Repolarization changes | Asymmetric T-wave inversion in lateral leads |
ECG Image
LVH with Strain Pattern — tall R-waves in lateral leads, deep S in V1–V2, ST/T changes:
7. 🫀 Wolff-Parkinson-White (WPW) Syndrome
Overview
An accessory conduction pathway (Bundle of Kent) bypasses the AV node, causing ventricular pre-excitation. Patients are prone to supraventricular tachycardias, including AVRT and AF with rapid conduction — the latter can trigger ventricular fibrillation.
ECG Changes
| Feature | Description |
|---|---|
| Short PR interval | <120 ms (bypasses AV nodal delay) |
| Delta wave | Slurred upstroke at beginning of QRS |
| Wide QRS | >120 ms (fusion of normal conduction + pre-excitation) |
| Secondary ST-T changes | Discordant T-waves (repolarization abnormality) |
| Pseudo-infarct pattern | Negative delta waves in inferior leads can mimic Q-waves |
ECG Image
WPW Syndrome — short PR, delta waves, and widened QRS with secondary repolarization changes:
8. 🫀 Right Bundle Branch Block (RBBB)
Overview
Conduction delay or failure in the right bundle branch. Can be a normal variant or associated with right heart disease, PE, congenital heart disease, or ischemia.
ECG Changes
| Feature | Description |
|---|---|
| Wide QRS | >120 ms (complete RBBB); 100–119 ms (incomplete) |
| RSR' pattern in V1 | "Rabbit-ear" or "M-shaped" morphology |
| Slurred S-waves | Wide S in leads I, V5, V6 ("lateral leads") |
| T-wave inversion | In V1–V3 (secondary repolarization change) |
| ST depression | V1–V3 (secondary change, not ischemia) |
ECG Image
Complete RBBB — RSR' in V1, slurred S in I/V6, secondary T-wave inversions V1–V3:
9. 🫀 Pulmonary Embolism (PE)
Overview
Acute obstruction of the pulmonary vasculature causing acute right ventricular pressure overload. ECG changes reflect acute RV strain but are neither sensitive nor specific — diagnosis requires CT pulmonary angiography.
ECG Changes
| Feature | Description |
|---|---|
| Sinus tachycardia | Most common finding (70%+) |
| S1Q3T3 pattern | Deep S in lead I, Q-wave in III, T-inversion in III |
| New RBBB | Acute right ventricular strain/dilatation |
| Right axis deviation | From RV pressure overload |
| T-wave inversions V1–V4 | Right ventricular strain pattern |
| P-pulmonale | Tall, peaked P-waves (right atrial enlargement) |
ECG Image
Pulmonary Embolism — sinus tachycardia with S1Q3T3 pattern highlighted:
10. 🫀 Dilated Cardiomyopathy (DCM)
Overview
Global ventricular dilatation with reduced systolic function (reduced EF). Causes include idiopathic, alcohol, viral myocarditis, ischemia, and chemotherapy.
ECG Changes
| Feature | Description |
|---|---|
| Left bundle branch block (LBBB) | Wide QRS >120 ms, broad notched R in V6, no septal Q in I/aVL/V6 |
| Atrial fibrillation | Common, from atrial dilatation |
| PVCs / ventricular ectopics | Common, risk of VT/VF |
| Left axis deviation | From ventricular remodeling |
| Prolonged PR | First-degree AV block |
| Nonspecific ST-T changes | Diffuse repolarization abnormalities |
| Low voltage | If pericardial effusion coexists |
ECG Image
DCM — sinus tachycardia, right axis deviation, nonspecific ST-T changes in a child with familial DCM:
Quick-Reference Summary Table
| Disease | Key ECG Finding | Distinguishing Feature |
|---|---|---|
| STEMI | ST elevation in contiguous leads | Reciprocal changes, territory-based |
| Atrial Fibrillation | No P-waves, irregular rhythm | Irregularly irregular R-R |
| Complete Heart Block | AV dissociation | P and QRS march independently |
| Ventricular Tachycardia | Wide complex tachycardia | Capture/fusion beats, concordance |
| Pericarditis | Diffuse saddle-shaped ST elevation | PR depression, all leads except aVR |
| LVH | High-voltage QRS | Strain pattern in I, aVL, V5–V6 |
| WPW | Short PR + delta wave | Pre-excitation; wide QRS |
| RBBB | RSR' in V1, slurred S in V6 | Secondary T-wave changes V1–V3 |
| Pulmonary Embolism | Sinus tachycardia + S1Q3T3 | New RBBB, right axis deviation |
| Dilated Cardiomyopathy | LBBB, AF, diffuse ST-T changes | Broad notched R in V6, no septal Q |
Clinical Note: ECG findings must always be interpreted in clinical context. Many of these patterns overlap, and serial ECGs are often essential for diagnosis. Any hemodynamically unstable patient with ECG changes requires urgent cardiology review.
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