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):

Territory	Leads with ST Elevation	Artery
Anteroseptal	V1–V3	LAD proximal
Anterior	V1–V4	LAD
Anterolateral	V1–V6, I, aVL	Proximal LAD
Lateral	I, aVL	LCx
Inferior	II, III, aVF	RCA
Posterior	Tall R in V1–V2, R/S ≥1	LCx/RCA
Right ventricular	II, III, aVF + V3R–V6R elevation	RCA

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

Disease	Key ECG Finding
STEMI	ST elevation + reciprocal depression + Q waves
NSTEMI / Unstable Angina	ST depression / T-wave inversion (no elevation)
Atrial Fibrillation	Irregularly irregular, no P waves
Complete Heart Block	AV dissociation, slow escape rhythm
WPW	Short PR + delta wave + wide QRS
Pulmonary Embolism	S1Q3T3 + sinus tachycardia + RBBB pattern
LVH	Voltage criteria + lateral strain pattern
LBBB	Wide QRS + broad R lateral + QS V1–V3
RBBB	Wide 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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