Tell me 10 common heart diseases with ecg graph and changes occur in ecg
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ECG changes heart diseases electrocardiogram
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atrial fibrillation ECG rhythm strip
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ST elevation myocardial infarction STEMI ECG
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ventricular tachycardia ECG wide QRS
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left ventricular hypertrophy ECG voltage criteria
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heart block AV block first degree second degree third degree ECG PR interval
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pericarditis ECG saddle shape ST elevation diffuse
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pulmonary embolism ECG S1Q3T3 right heart strain
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Wolff-Parkinson-White WPW syndrome ECG delta wave short PR
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hypertrophic cardiomyopathy ECG deep Q waves septal hypertrophy
I now have comprehensive ECG images and data for all 10 conditions. Let me compile the complete answer.
10 Common Heart Diseases with ECG Changes
1. 🫀 ST-Elevation Myocardial Infarction (STEMI)
Key ECG Changes:
- ST-segment elevation ≥1 mm in ≥2 contiguous leads (convex/tombstone morphology)
- Reciprocal ST depression in opposite leads
- Hyperacute T waves (tall, broad, peaked) — earliest sign
- Pathological Q waves develop within hours (>40 ms wide, >25% R-wave height) — marker of necrosis
- T-wave inversion in evolutionary phase
Lead Localization:
| Territory | Elevated Leads | Reciprocal Depression |
|---|---|---|
| Anterior (LAD) | V1–V4 | II, III, aVF |
| Inferior (RCA) | II, III, aVF | aVL, I |
| Lateral (LCx) | I, aVL, V5–V6 | II, III, aVF |
2. 🫀 Non-ST-Elevation ACS (NSTEMI / Unstable Angina)
Key ECG Changes:
- ST depression (horizontal or downsloping) ≥0.5–1 mm in ≥2 contiguous leads
- T-wave inversion — deep, symmetric (Wellens syndrome pattern: biphasic or deeply inverted T waves in V2–V3 = critical LAD stenosis)
- No ST elevation, no Q waves
- May have transient ST elevation during ischemic episode
3. 🫀 Atrial Fibrillation (AF)
Key ECG Changes:
- Absent P waves — replaced by irregular fibrillatory (f) waves (best seen in V1 and lead II), rate 350–600/min
- Irregularly irregular RR intervals — the hallmark
- Narrow QRS complexes (unless aberrant conduction or pre-excitation)
- Ventricular rate typically 100–180/min in uncontrolled AF
- If AF + regular slow ventricular rate → suspect complete heart block
4. 🫀 Ventricular Tachycardia (VT)
Key ECG Changes:
- Wide QRS complexes ≥120 ms (often ≥160 ms)
- Regular rapid rhythm — rate 100–250 bpm
- AV dissociation — P waves independent of QRS (hallmark of VT vs SVT)
- Fusion beats and capture beats (Dressler beats) — pathognomonic
- Concordance — all QRS complexes in V1–V6 pointing same direction
- No RBBB/LBBB typical morphology (Brugada criteria help distinguish from SVT with aberrancy)
5. 🫀 AV Heart Block (1°, 2°, 3°)
Key ECG Changes:
| Type | ECG Finding |
|---|---|
| 1° AV Block | PR interval >200 ms (1 large box); every P conducts |
| 2° Mobitz I (Wenckebach) | Progressive PR lengthening until a QRS is dropped; RR shortens before dropped beat |
| 2° Mobitz II | Fixed PR interval, then sudden non-conducted P wave — higher risk |
| 3° (Complete) Block | Complete AV dissociation — atrial rate > ventricular rate; wide or junctional escape rhythm |
6. 🫀 Left Ventricular Hypertrophy (LVH)
Key ECG Changes:
- High voltage criteria (Sokolow-Lyon): S in V1 + R in V5 or V6 ≥35 mm
- Cornell criteria: R in aVL + S in V3 >28 mm (men) / >20 mm (women)
- LV strain pattern: ST depression + T-wave inversion in lateral leads (I, aVL, V5–V6)
- Left axis deviation
- Prolonged QRS duration (can reach 110 ms)
- Left atrial enlargement: bifid P wave (P mitrale) in II, negative terminal component in V1
7. 🫀 Acute Pericarditis
Key ECG Changes (4 stages):
- Stage 1 (acute): Diffuse concave/saddle-shaped ST elevation in almost all leads (except aVR and V1 which show ST depression); PR depression (most sensitive early sign, best in lead II); Spodick's sign — downsloping TP segment
- Stage 2: ST normalizes, T waves flatten
- Stage 3: Diffuse T-wave inversions
- Stage 4: ECG returns to normal
Key Differentiator from STEMI: ST elevation is diffuse (not in one vascular territory), concave (not convex), and accompanied by PR depression.
8. 🫀 Pulmonary Embolism (PE)
Key ECG Changes:
- Sinus tachycardia — most common finding
- S1Q3T3 pattern: Deep S wave in lead I + Q wave in lead III + T-wave inversion in lead III (McGinn-White sign)
- Right bundle branch block (complete or incomplete) — right ventricular strain
- T-wave inversions in V1–V4 — right heart strain
- Right axis deviation
- P pulmonale (tall peaked P in II >2.5 mm) in massive PE
- Atrial fibrillation may be precipitated
9. 🫀 Wolff-Parkinson-White (WPW) Syndrome
Key ECG Changes:
- Short PR interval <120 ms (bypasses AV node via accessory pathway)
- Delta wave — slurred, slow upstroke at the start of the QRS (signature finding)
- Wide QRS >120 ms (due to pre-excitation + delta wave)
- Secondary ST-T wave changes (discordant to QRS)
- "Pseudo-infarction" pattern — negative delta waves mimic pathological Q waves in inferior leads
- Accessory pathway location can be estimated from delta wave polarity:
- Positive delta in V1 → left-sided pathway
- Negative delta in inferior leads → posteroseptal pathway
10. 🫀 Hypertrophic Cardiomyopathy (HCM)
Key ECG Changes:
- High-voltage LVH pattern — Sokolow-Lyon ≥35 mm
- Deep, narrow "dagger-like" Q waves in lateral (I, aVL, V5–V6) and inferior (II, III, aVF) leads — due to septal hypertrophy
- Giant T-wave inversions in V3–V5 — especially in apical HCM (Yamaguchi syndrome, inversions >10 mm)
- ST-segment depression (strain pattern) in lateral leads
- Atrial fibrillation — common complication
- Left axis deviation and prolonged QRS in advanced cases
- Absence of septal Q waves can occur in severe septal HCM
Quick Reference Summary Table
| # | Disease | Key ECG Finding | Rate/Rhythm |
|---|---|---|---|
| 1 | STEMI | ST elevation (convex) + Q waves | Sinus, varies |
| 2 | NSTEMI/UA | ST depression + T inversion | Sinus |
| 3 | Atrial Fibrillation | No P waves, irregular RR | Irregular 100–180 |
| 4 | Ventricular Tachycardia | Wide QRS + AV dissociation | Regular 100–250 |
| 5 | AV Heart Block | PR prolonged / dropped QRS / AV dissociation | Slow |
| 6 | LVH | High voltage + strain pattern | Sinus |
| 7 | Pericarditis | Diffuse concave ST elevation + PR depression | Sinus, ±tachycardia |
| 8 | Pulmonary Embolism | S1Q3T3 + RBBB + sinus tachycardia | Sinus tachycardia |
| 9 | WPW Syndrome | Short PR + delta wave + wide QRS | Sinus ±tachycardia |
| 10 | HCM | Deep Q waves + giant T inversions + LVH | Sinus, ±AF |
Source: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine; ROSEN's Emergency Medicine: Concepts and Clinical Practice
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