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Give common heart disease name and their ecg changes and images

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ECG electrocardiogram heart disease changes myocardial infarction atrial fibrillation

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STEMI ST elevation myocardial infarction ECG 12-lead

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ventricular hypertrophy ECG changes left right bundle branch block

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atrial fibrillation ECG irregularly irregular no P waves

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complete heart block third degree AV block ECG

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Wolff-Parkinson-White WPW syndrome delta wave ECG

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pulmonary embolism ECG S1Q3T3 right heart strain

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Common Heart Diseases & Their ECG Changes

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Changes:
  • Hyperacute T waves — earliest change (tall, peaked T waves)
  • ST-segment elevation ≥1 mm in ≥2 contiguous leads (convex/tombstone morphology)
  • Pathological Q waves — develops over hours (>0.04 s wide, >25% R wave depth) — sign of necrosis
  • T-wave inversion — evolves after acute phase
  • Reciprocal ST depression in opposite leads
Localisation by ECG (from Tintinalli's Emergency Medicine):
TerritoryLeads with ST ElevationArtery
AnteroseptalV1–V3LAD proximal
AnteriorV1–V4LAD
AnterolateralV1–V6, I, aVLProximal LAD
LateralI, aVLLCx
InferiorII, III, aVFRCA
PosteriorTall R in V1–V2, R/S ≥1LCx/RCA
Right ventricularII, III, aVF + V3R–V6R elevationRCA
ECG Images — Anterior STEMI:
Anterior STEMI - LAD occlusion with tombstone ST elevation V2-V6
Anterolateral STEMI with hyperacute T waves and reciprocal inferior depression
Inferior STEMI in context of atrial fibrillation - ST elevation II, III, aVF with reciprocal changes

2. 💓 Atrial Fibrillation (AF)

ECG Changes:
  • Absent P waves — replaced by chaotic fibrillatory (f) waves (best seen in V1)
  • Irregularly irregular R-R intervals — hallmark feature
  • Narrow QRS (unless aberrant conduction or bundle branch block)
  • Rate: Ventricular response varies; rapid (>100 bpm) = AF with RVR
ECG Images:
Classic atrial fibrillation - irregularly irregular rhythm, absent P waves, fine f waves in V1
Coarse atrial fibrillation with prominent fibrillatory baseline

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

ECG Changes:
  • Complete AV dissociation — P waves and QRS complexes march independently
  • P waves regular at faster atrial rate (60–100 bpm)
  • Ventricular escape rhythm: slow bradycardia (20–40 bpm)
  • Wide QRS if escape from ventricle (>120 ms); narrow if junctional escape
  • No fixed PR interval
ECG Images:
Third-degree complete heart block - P waves and QRS completely dissociated, ventricular escape rhythm
Complete AV block with narrow junctional escape rhythm at ~36 bpm

4. ⚡ Wolff-Parkinson-White (WPW) Syndrome

ECG Changes:
  • Short PR interval (<120 ms)
  • Delta wave — slurred upstroke at beginning of QRS (pre-excitation via accessory pathway)
  • Wide QRS (>120 ms) due to fusion beat
  • Secondary ST-T changes (discordant with QRS)
  • Risk: Pre-excited AF → rapid conduction → VF
ECG Images:
WPW syndrome - short PR, delta waves, widened QRS in sinus rhythm
WPW with negative delta waves in inferior leads mimicking inferior Q waves

5. 🫁 Pulmonary Embolism (PE)

ECG Changes:
  • Sinus tachycardia — most common finding (~40% of cases)
  • S1Q3T3 pattern — S wave in lead I + Q wave + T-wave inversion in lead III (right heart strain)
  • T-wave inversions V1–V4 — RV strain pattern
  • Incomplete/complete RBBB — due to acute RV dilation
  • Right axis deviation, P pulmonale
  • AF — occurs in 10–35% of patients
ECG Images:
Classic S1Q3T3 pattern in pulmonary embolism with sinus tachycardia
PE with S1Q3T3, incomplete RBBB, and T-wave inversions V1-V3

6. 🏋️ Left Ventricular Hypertrophy (LVH)

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) or ≥ 20 mm (women)
  • Left axis deviation
  • ST depression + T-wave inversion in lateral leads (V5–V6, I, aVL) — "strain pattern"
  • Left atrial enlargement (P-mitrale: wide, notched P wave in II; biphasic P in V1)

7. 🔀 Left Bundle Branch Block (LBBB)

ECG Changes:
  • Wide QRS ≥120 ms
  • Broad notched/slurred R in lateral leads (I, aVL, V5–V6) — "M-shaped"
  • Deep S/QS in right precordial leads (V1–V3)
  • ST and T changes discordant to QRS (opposite direction)
  • Loss of normal septal Q waves in lateral leads
  • New LBBB in chest pain = STEMI equivalent until proven otherwise
ECG Image:
LBBB with wide QRS >120ms, broad R in lateral leads, deep S in V1-V3, discordant ST-T changes

8. ➡️ Right Bundle Branch Block (RBBB)

ECG Changes:
  • Wide QRS ≥120 ms
  • RSR' ("rabbit ears") pattern in V1–V2
  • Broad slurred S wave in lateral leads (I, V5–V6)
  • T-wave inversion in V1–V3 (secondary change)
  • Can be normal variant or indicate RV pressure overload
ECG Image:
RBBB with RSR' in V1, broad S in lateral leads, compared to baseline LVH tracing

Quick Reference Summary

DiseaseKey ECG Finding
STEMIST elevation + reciprocal depression + Q waves
NSTEMI / Unstable AnginaST depression / T-wave inversion (no elevation)
Atrial FibrillationIrregularly irregular, no P waves
Complete Heart BlockAV dissociation, slow escape rhythm
WPWShort PR + delta wave + wide QRS
Pulmonary EmbolismS1Q3T3 + sinus tachycardia + RBBB pattern
LVHVoltage criteria + lateral strain pattern
LBBBWide QRS + broad R lateral + QS V1–V3
RBBBWide QRS + RSR' in V1 + broad S lateral
Sources: Tintinalli's Emergency Medicine (9th ed.) — ECG ST-Segment Criteria Table 49-4; Ganong's Review of Medical Physiology; Goldman-Cecil Medicine
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