Explain me 10 common heart disease with ecg changes and ECG diagram
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ECG electrocardiogram changes heart disease myocardial infarction atrial fibrillation
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STEMI inferior anterior ECG ST elevation myocardial infarction 12-lead
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atrial flutter ventricular tachycardia ECG sawtooth pattern
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Wolff-Parkinson-White syndrome ECG delta wave short PR interval left ventricular hypertrophy
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complete heart block third degree AV block pericarditis hyperkalemia ECG
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ventricular tachycardia wide QRS monomorphic polymorphic ECG torsades de pointes
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pericarditis diffuse ST elevation saddle shape ECG PR depression
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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia
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left ventricular hypertrophy ECG Sokolow-Lyon voltage criteria tall R wave
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hyperkalemia peaked T wave ECG sine wave widened QRS electrolyte
Here is a comprehensive guide to 10 common heart diseases with ECG changes and diagrams, sourced from Harrison's, Ganong's, Braunwald's, and Tintinalli's Emergency Medicine.
10 Common Heart Diseases with ECG Changes
1. 🫀 ST-Elevation Myocardial Infarction (STEMI)
ECG Changes
- Hyperacute T-waves (earliest sign — tall, peaked, broad-based)
- ST-segment elevation ≥1 mm in ≥2 contiguous leads (convex/tombstone morphology)
- Pathological Q waves (>40 ms wide, >25% of R-wave height) — appear within hours to days
- Reciprocal ST depression in opposite leads
- T-wave inversion in the subacute phase
| Infarct Territory | Elevated ST Leads | Reciprocal Depression |
|---|---|---|
| Anterior (LAD) | V1–V4 | II, III, aVF |
| Inferior (RCA) | II, III, aVF | I, aVL |
| Lateral (LCx) | I, aVL, V5–V6 | V1–V3 |
| Posterior | V7–V9 | V1–V3 (tall R) |
Source: Ganong's Review of Medical Physiology, 26e; Harrison's Principles 22E
Anterior STEMI (LAD occlusion) — tombstoning V2–V4:
Inferior STEMI (RCA occlusion) — ST elevation II, III, aVF:
2. 🫀 Non-ST-Elevation Myocardial Infarction (NSTEMI) / Unstable Angina
ECG Changes
- ST depression (horizontal or downsloping) ≥0.5 mm in ≥2 contiguous leads
- T-wave inversion (symmetric, deep — Wellens' pattern in proximal LAD stenosis)
- No pathological Q waves (distinguishes from STEMI)
- No ST elevation (by definition)
- May have normal ECG in up to 6% of cases
Source: Tintinalli's Emergency Medicine; Lippincott Pharmacology
3. 🫀 Atrial Fibrillation (AF)
ECG Changes
- Absent P waves — replaced by chaotic fibrillatory (f) waves (especially visible in V1)
- Irregularly irregular RR intervals (the hallmark)
- Narrow QRS (unless aberrant conduction or bundle branch block)
- Ventricular rate variable: 100–180 bpm (uncontrolled), <100 bpm (rate-controlled)
- Coarse vs. fine fibrillatory baseline
Source: Harrison's 22E; Braunwald's Heart Disease; Ganong's Physiology
4. 🫀 Atrial Flutter
ECG Changes
- Sawtooth flutter (F) waves at ~300 bpm — best seen in II, III, aVF, and V1
- Regular atrial rate ~250–350 bpm (typical flutter ~300 bpm)
- AV conduction ratio typically 2:1 (ventricular rate ~150 bpm), may be 3:1 or 4:1
- Narrow QRS (unless aberrant conduction)
- No isoelectric baseline between flutter waves (distinguishes from multifocal atrial tachycardia)
Source: Ganong's Physiology 26e; Tintinalli's
5. 🫀 Third-Degree (Complete) Heart Block
ECG Changes
- Complete AV dissociation — P waves and QRS complexes are independent of each other
- P-wave rate > QRS rate (e.g., atrial rate 80 bpm, ventricular rate 30–45 bpm)
- No relationship between P waves and QRS complexes (PR interval varies)
- Escape rhythm: narrow QRS if junctional (40–60 bpm); wide QRS if ventricular (20–40 bpm)
- Bradycardia, often symptomatic
Source: Washington Manual of Medical Therapeutics; Braunwald's
6. 🫀 Wolff-Parkinson-White (WPW) Syndrome
ECG Changes (Classic Triad)
- Short PR interval (<120 ms) — accessory pathway bypasses AV node delay
- Delta wave — slurred upstroke at the start of QRS (pre-excitation of ventricle)
- Wide QRS (>120 ms) — due to fusion of normal and accessory pathway depolarization
- Secondary ST-T changes — discordant to delta wave direction
- "Pseudo-infarction" pattern — negative delta waves in inferior leads can mimic Q waves
Risk: Pre-excited atrial fibrillation → ventricular fibrillation (life-threatening)
Source: Braunwald's Heart Disease
7. 🫀 Ventricular Tachycardia / Torsades de Pointes
ECG Changes — Monomorphic VT
- Wide QRS (>120 ms), rate 100–250 bpm
- Regular RR intervals
- AV dissociation, fusion beats, capture beats
- LBBB or RBBB morphology
ECG Changes — Torsades de Pointes (Polymorphic VT)
- "Twisting of the points" — QRS axis rotates around the isoelectric baseline
- Irregular, wide-complex tachycardia
- Preceded by long QTc (>500 ms), often with long-short-long RR sequence
- Can degenerate into ventricular fibrillation
Source: Tintinalli's Emergency Medicine; Braunwald's Heart Disease
8. 🫀 Acute Pericarditis
ECG Changes (4 stages)
| Stage | Timing | ECG Finding |
|---|---|---|
| Stage 1 | Day 1–2 | Diffuse concave ("saddle-shaped") ST elevation + PR depression in most leads; PR elevation + ST depression in aVR |
| Stage 2 | Days–weeks | ST normalizes, T waves flatten |
| Stage 3 | Weeks | T-wave inversion (diffuse) |
| Stage 4 | Months | ECG normalizes |
Key distinguishing features from STEMI:
- Diffuse ST elevation (not confined to one coronary territory)
- Spodick's sign — downsloping TP segment
- PR depression in leads II, V4–V6
- No reciprocal ST depression (except aVR)
- No Q waves
Source: Tintinalli's Emergency Medicine; Braunwald's
9. 🫀 Pulmonary Embolism (PE)
ECG Changes
- Sinus tachycardia (most common finding ~44%)
- S1Q3T3 pattern (McGinn-White sign): deep S in I, Q wave in III, T-wave inversion in III — present in ~12–20%
- Right bundle branch block (complete or incomplete) — rSR' in V1
- T-wave inversions in V1–V3 (right ventricular strain)
- Right axis deviation
- Atrial arrhythmias (AF, flutter)
- P pulmonale (peaked P >2.5 mm in II) — right atrial enlargement
Source: Harrison's 22E; Tintinalli's Emergency Medicine
10. 🫀 Left Ventricular Hypertrophy (LVH) / Hypertensive Heart Disease
ECG Changes
- High-voltage QRS (Sokolow-Lyon criteria: S in V1 + R in V5 or V6 ≥35 mm)
- Cornell criteria: R in aVL + S in V3 >28 mm (men) / >20 mm (women)
- Left axis deviation
- ST depression + T-wave inversion in lateral leads (I, aVL, V5, V6) — the "strain pattern"
- Prolonged QRS duration
- Left atrial enlargement (biphasic P in V1 with deep terminal component)
Source: Harrison's 22E; Ganong's Physiology
BONUS — Hyperkalemia (common electrolyte cause of ECG changes):
| K+ Level | ECG Change |
|---|---|
| 5.5–6.5 mEq/L | Tall, peaked ("tented") T waves — narrow base |
| 6.5–8.0 mEq/L | Flattened/absent P waves, prolonged PR, wide QRS |
| >8.0 mEq/L | Sine-wave pattern → ventricular fibrillation → asystole |
Quick Reference Summary Table
| # | Disease | Key ECG Changes |
|---|---|---|
| 1 | STEMI | ST elevation, Q waves, reciprocal depression, hyperacute T |
| 2 | NSTEMI/UA | ST depression, T-wave inversion, no Q waves |
| 3 | Atrial Fibrillation | No P waves, irregularly irregular, f-waves |
| 4 | Atrial Flutter | Sawtooth F-waves ~300 bpm, 2:1–4:1 block |
| 5 | Complete Heart Block | AV dissociation, P rate > QRS rate, escape rhythm |
| 6 | WPW Syndrome | Short PR, delta wave, wide QRS, pseudoinfarction |
| 7 | VT / Torsades | Wide QRS tachycardia, twisting QRS axis (TdP), long QTc |
| 8 | Pericarditis | Diffuse saddle ST elevation, PR depression, no Q waves |
| 9 | Pulmonary Embolism | S1Q3T3, sinus tachycardia, T inversion V1–V3, RBBB |
| 10 | LVH / Hypertension | High voltage, strain pattern, left axis deviation |
Sources: Ganong's Review of Medical Physiology 26e; Harrison's Principles of Internal Medicine 22E; Braunwald's Heart Disease; Tintinalli's Emergency Medicine; Washington Manual of Medical Therapeutics
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