Explain me 10common heart diseases with ECG. Changes and ECG image of those diseases.

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ECG electrocardiogram myocardial infarction ST elevation

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atrial fibrillation ECG irregular rhythm absent P waves

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heart block complete AV block ECG third degree

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ventricular tachycardia ECG wide complex tachycardia

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left ventricular hypertrophy ECG voltage criteria

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Wolff-Parkinson-White syndrome ECG delta wave short PR interval

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pericarditis ECG saddle shaped ST elevation diffuse

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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia

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hypertrophic cardiomyopathy ECG deep Q waves LVH pattern

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dilated cardiomyopathy ECG left bundle branch block poor R wave progression

Here is a comprehensive guide to 10 common heart diseases with their characteristic ECG changes and representative ECG images.

10 Common Heart Diseases: ECG Changes & Images

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Changes

Phase	Changes
Hyperacute	Tall, peaked (hyperacute) T waves
Acute	Convex ("tombstone") ST elevation ≥ 1 mm in ≥ 2 contiguous leads
Evolving	Pathological Q waves (>40 ms wide, >25% of R-wave height), T-wave inversion
Old	Persistent Q waves, normalized ST segments

Reciprocal ST depression in opposite leads (e.g., inferior STEMI → ST depression in I, aVL).

Localization:

Anterior (V1–V4) → LAD occlusion
Inferior (II, III, aVF) → RCA or LCx occlusion
Lateral (I, aVL, V5–V6) → LCx occlusion

Acute Anterior STEMI — ST elevation V1–V6 with reciprocal depression in inferior leads

Inferolateral STEMI — ST elevation in II, III, aVF, V4–V6 with reciprocal changes in I, aVL

2. 🫀 Atrial Fibrillation (AF)

ECG Changes

Absent P waves — replaced by irregular fibrillatory baseline (best seen in V1)
Irregularly irregular RR intervals — the hallmark finding
Rapid ventricular response when uncontrolled (HR > 100 bpm)
Narrow QRS (unless aberrant conduction or accessory pathway)
No fixed PR interval

Key distinction from atrial flutter: AF has chaotic baseline, flutter has organized "sawtooth" pattern at ~300 bpm

Atrial Fibrillation with rapid ventricular response — absent P waves, irregularly irregular rhythm

3. 🫀 Complete (Third-Degree) AV Block

ECG Changes

Complete AV dissociation — P waves and QRS complexes are independent
Regular P-P intervals; regular R-R intervals — but at different rates
Atrial rate > Ventricular rate (atria ~60–100 bpm; ventricles ~20–40 bpm)
Escape rhythm:
- Junctional escape → narrow QRS (~40–60 bpm)
- Ventricular escape → wide QRS (>120 ms), ~20–40 bpm
No consistent PR interval — P waves "march through" QRS complexes

Third-degree heart block — complete AV dissociation, slow ventricular escape with wide QRS

Third-degree heart block — narrow junctional escape rhythm, regular P-P and R-R with no relationship

4. 🫀 Ventricular Tachycardia (VT)

ECG Changes

Wide QRS tachycardia (QRS > 120 ms) at rate > 100 bpm
Monomorphic: uniform QRS morphology beat-to-beat
AV dissociation — P waves independent of QRS (pathognomonic when visible)
Fusion beats and capture beats — diagnostic
Positive or negative concordance across all precordial leads
Axis deviation (commonly superior axis/extreme left axis)

Brugada criteria help differentiate VT from SVT with aberrancy

Monomorphic VT — wide complex tachycardia with AV dissociation and positive precordial concordance

Fascicular VT (Belhassen) — RBBB morphology + left axis deviation

5. 🫀 Acute Pericarditis

ECG Changes (4 Stages)

Stage	Timing	ECG Finding
I	Days 1–2	Diffuse concave ("saddle-shaped") ST elevation in almost all leads; PR depression (II, V5); PR elevation in aVR
II	Days 3–7	ST normalizes; T waves flatten
III	Week 2	T-wave inversions (generalized)
IV	Weeks later	Normalization

Key differentiator from STEMI:

ST elevation is diffuse (not localised to one territory)
ST is concave up (not convex/tombstone)
PR segment depression — highly specific
No reciprocal changes (except aVR)
Spodick's sign — downsloping TP segment

Acute pericarditis — diffuse saddle-shaped ST elevation, PR depression in II, PR elevation in aVR

6. 🫀 Pulmonary Embolism (PE)

ECG Changes

Most common finding is sinus tachycardia (seen in >40%). Classic but less common:

Finding	Description
S1Q3T3	Deep S wave in I, Q wave in III, T-wave inversion in III
Right heart strain	T-wave inversions in V1–V4
Incomplete/complete RBBB	rSR' in V1
Right axis deviation	QRS axis >+90°
P pulmonale	Tall peaked P waves in II (right atrial enlargement)
Sinus tachycardia	Most common (>100 bpm)

Pulmonary embolism ECG — sinus tachycardia, classic S1Q3T3 pattern with T inversion in III

PE with S1Q3T3 annotated — S wave in I (blue), Q wave in III (red), inverted T in III (yellow)

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

ECG Changes (Classic Triad)

Short PR interval (< 120 ms) — due to accessory pathway bypassing AV node
Delta wave — slurred initial upstroke of QRS (ventricular pre-excitation)
Wide QRS complex (> 120 ms) — secondary to delta wave
Secondary ST-T changes — discordant, not ischemic

Pathway localization by delta wave polarity:

Positive delta in V1 → left-sided pathway
Negative delta in inferior leads → posteroseptal pathway
"Pseudo-infarction" Q waves can occur (mimics MI)

Risk: WPW + AF → very rapid ventricular response (antidromic conduction) → VF

WPW — short PR, prominent delta waves, widened QRS across precordial leads

WPW with posteroseptal pathway — negative delta waves in inferior leads (pseudo-Q waves)

8. 🫀 Left Ventricular Hypertrophy (LVH)

ECG Changes

Voltage criteria (increased QRS amplitude):

Sokolow-Lyon: S in V1 + R in V5 or V6 > 35 mm
Cornell: R in aVL + S in V3 > 28 mm (men) / > 20 mm (women)
R in aVL > 11–12 mm

Strain pattern (repolarization abnormality):

ST depression and T-wave inversion in lateral leads (I, aVL, V5–V6)
Downsloping ST segment

Additional findings:

Left axis deviation
Prolonged QRS (borderline wide)
Left atrial enlargement (notched P waves, prolonged P duration)

LVH — Cornell voltage criteria with high R in aVL, deep S in V3, lateral strain pattern (T inversions)

9. 🫀 Hypertrophic Cardiomyopathy (HCM)

ECG Changes

LVH voltage criteria (high QRS voltages, especially precordial)
Deep narrow Q waves (septal hypertrophy) in I, aVL, V4–V6 — "dagger Q waves"
Giant T-wave inversions in precordial leads — especially prominent in apical HCM (Yamaguchi syndrome) reaching >10 mm depth in V3–V4
ST-segment depression (strain pattern)
Left axis deviation
Atrial fibrillation or flutter (common complication)
Prolonged QTc may occur

Apical HCM — giant symmetric T-wave inversions in V3–V5, high LVH voltage

HCM (septal variant) — high voltage, strain pattern V2–V6, prominent T-wave inversions, positive T in aVR

10. 🫀 Dilated Cardiomyopathy (DCM)

ECG Changes

Left Bundle Branch Block (LBBB) — most characteristic finding
- Wide QRS (> 120 ms)
- Broad, notched "M-shaped" R waves in I, aVL, V5–V6
- Deep QS in V1–V3
- Discordant ST-T changes
Poor R-wave progression in precordial leads (V1–V4)
Left axis deviation
Sinus tachycardia with compensatory tachycardia in heart failure
Atrial fibrillation (common)
Low QRS voltage (if diffuse myocardial involvement)
Prolonged QRS predicts worse prognosis; indication for CRT if LBBB + EF ≤ 35%

DCM with LBBB — wide QRS, monophasic R in lateral leads, deep S in V1–V3

DCM with incomplete LBBB — poor R-wave progression, global LV and LA dilatation on echo (panel B)

Quick Reference Summary Table

Disease	Rate	Rhythm	P Wave	PR	QRS	ST-T Changes
STEMI	Variable	Sinus	Normal	Normal	Normal → Q waves	ST elevation (convex) + reciprocal depression
Atrial Fibrillation	Variable	Irregular	Absent (fibrillatory)	None	Narrow	Non-specific
3° AV Block	Atria fast, ventricles slow	Dissociated	Present, regular	No relationship	Wide (ventricular) or narrow (junctional)	Secondary changes
Ventricular Tachycardia	>100	Regular	Dissociated	AV dissociation	Wide (>120 ms)	Discordant
Pericarditis	Normal/fast	Sinus	Normal	PR depression	Normal	Diffuse concave ST elevation
Pulmonary Embolism	Fast	Sinus tach	P pulmonale	Normal	Normal/RBBB	S1Q3T3, T inv V1–V4
WPW Syndrome	Variable	Sinus/SVT	Normal	Short (<120 ms)	Wide + delta wave	Secondary
LVH	Normal	Sinus	Left atrial pattern	Normal	High voltage	Lateral strain
HCM	Normal	Sinus/AF	Enlarged	Normal	High voltage, Q waves	Giant T inversions
DCM	Fast/variable	Sinus/AF	Enlarged	Normal	LBBB, wide	Discordant ST-T

Clinical Note: ECG changes must always be interpreted in clinical context. A single ECG finding rarely diagnoses disease alone — always correlate with symptoms, history, and other investigations (echo, troponins, CT-PA, etc.).

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