Explain me 10 common heart disease with ECG change and ECG images

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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 ECG PR interval prolonged complete AV block

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ventricular fibrillation ventricular tachycardia ECG chaotic rhythm

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Wolff-Parkinson-White WPW syndrome delta wave ECG pre-excitation

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pulmonary embolism ECG S1Q3T3 right heart strain sinus tachycardia

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hypertrophic cardiomyopathy left ventricular hypertrophy ECG deep T wave inversion

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pericarditis ECG diffuse ST elevation saddle shape PR depression

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Brugada syndrome ECG right bundle branch block ST elevation V1 V2 V3

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long QT syndrome ECG torsades de pointes prolonged QTc

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

10 Common Heart Diseases: ECG Changes & Images

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Changes

Hyperacute T-waves (earliest sign — tall, peaked)
ST-segment elevation ≥1 mm in limb leads or ≥2 mm in precordial leads (convex/tombstone shape)
Reciprocal ST depression in opposite leads
Pathological Q waves (>40 ms, >25% of R-wave height) — develop over hours
T-wave inversion in the affected territory

Localization by Lead

Territory	Leads with ST Elevation	Artery
Anterior	V1–V4	LAD
Anterolateral	V1–V6, I, aVL	Proximal LAD
Inferior	II, III, aVF	RCA or LCx
Lateral	I, aVL, V5–V6	LCx

ECG Image — Anterior STEMI

Anterior STEMI ECG showing tombstone ST elevation in V1-V6

Classic "tombstone" ST elevation across V2–V5 with reciprocal ST depression in II, III, aVF — proximal LAD occlusion.

ECG Image — Inferolateral STEMI

Inferolateral STEMI ECG with inferior ST elevation and reciprocal changes

ST elevation (green circles) in II, III, aVF and V4–V6; reciprocal depression (yellow arrows) in I, aVL, and V2–V3.

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)
Narrow QRS complexes (unless aberrant conduction or pre-existing BBB)
Rate may be rapid (>100 bpm = AF with rapid ventricular response) or controlled
May show low voltage (pericardial effusion) or LVH voltage criteria

ECG Image — Atrial Fibrillation with Rapid Ventricular Response

Atrial fibrillation ECG with absent P waves and irregularly irregular rhythm

No P waves, chaotic baseline, irregularly irregular narrow QRS complexes — classic AF with rapid ventricular response and LVH voltage.

3. 🔁 AV Heart Blocks

ECG Changes by Degree

Type	Key ECG Feature
1st Degree	PR interval >200 ms, every P followed by QRS
2nd Degree Mobitz I (Wenckebach)	Progressive PR lengthening → dropped QRS
2nd Degree Mobitz II	Constant PR, sudden non-conducted P wave
3rd Degree (Complete)	AV dissociation — P waves and QRS completely independent

ECG Image — All 4 Degrees of AV Block

Comparison ECG showing all types of AV block from first degree to complete heart block

From top: (a) Complete heart block with AV dissociation and escape rhythm 41 bpm; (b) Mobitz II; (c) Wenckebach; (d) 1st degree block — all documented in a patient with myocarditis.

ECG Image — Extreme PR Prolongation (1st Degree Block)

First degree AV block ECG with markedly prolonged PR interval of 512ms

PR interval 512 ms — markedly prolonged, every P still followed by a QRS.

4. ⚡ Ventricular Fibrillation (VF) & Ventricular Tachycardia (VT)

Ventricular Tachycardia

Wide QRS complexes (>120 ms) at rate >100 bpm
AV dissociation (P waves march through independently)
Fusion beats and capture beats (pathognomonic)
Monomorphic: uniform QRS morphology
Polymorphic: varying QRS — consider long QT or ischemia

Ventricular Fibrillation

Completely chaotic, irregular oscillations — no recognizable P, QRS, or T
No organized ventricular activity
Immediately life-threatening — cardiac arrest

ECG Image — VF, VT, and PVBs Comparison

ECG comparison of premature ventricular beats, ventricular tachycardia, and ventricular fibrillation

Top: PVBs (ectopic wide beats with compensatory pause). Middle: Monomorphic VT (rapid, regular, wide-complex). Bottom: VF (chaotic undulations, no organized waveforms).

ECG Image — VF Transition from VT

Ventricular fibrillation chaotic ECG rhythm

Disorganized, chaotic electrical activity — no P waves, QRS, or T waves identifiable. Pathognomonic VF pattern.

5. 🔌 Wolff-Parkinson-White (WPW) Syndrome

ECG Changes

Short PR interval (<120 ms) — bypass tract conducts faster than AV node
Delta wave — slurred initial QRS upstroke (accessory pathway pre-excitation)
Widened QRS (>120 ms total) due to fusion of delta + normal conduction
Secondary ST-T changes — discordant repolarization
Negative delta waves in inferior leads → posteroseptal pathway
Risk of pre-excited AF → degeneration to VF

ECG Image — WPW with Classic Delta Waves

Wolff-Parkinson-White ECG showing delta waves and short PR interval

Red arrows highlight delta waves in leads II and III. Short PR, widened QRS, and anteroseptal pathway morphology.

ECG Image — WPW Posteroseptal Pathway

WPW ECG with negative delta waves in inferior leads suggesting posteroseptal accessory pathway

Negative delta waves in II, III, aVF mimic inferior pseudo-infarct Q waves. Positive delta in V1 → posteroseptal accessory pathway.

6. 🫁 Acute Pulmonary Embolism (PE)

ECG Changes

Sinus tachycardia (most common finding)
S1Q3T3 pattern — S wave in lead I, Q wave and T-wave inversion in lead III
Right bundle branch block (complete or incomplete) — acute right heart strain
T-wave inversions in V1–V4 — right ventricular strain pattern
Right axis deviation
P pulmonale (peaked P waves in inferior leads)
Atrial fibrillation (less common)

ECG Image — S1Q3T3 with Sinus Tachycardia

Pulmonary embolism ECG with S1Q3T3 pattern and sinus tachycardia

Sinus tachycardia 116 bpm, S1Q3T3 pattern, T-wave inversions V1–V3, incomplete RBBB — classic acute PE pattern.

ECG Image — Annotated S1Q3T3

PE ECG with labeled S wave in lead I, Q wave and T-wave inversion in lead III

Annotated arrows pointing to: prominent S in I, pathological Q in III, inverted T in III — sinus tachycardia throughout.

7. 🧱 Hypertrophic Cardiomyopathy (HCM)

ECG Changes

Left ventricular hypertrophy (LVH) — Sokolow-Lyon: S in V1 + R in V5/V6 ≥35 mm
Giant, deep symmetric T-wave inversions in precordial leads (V2–V5) — especially apical HCM (Yamaguchi syndrome)
Abnormal Q waves in I, aVL, V5–V6 (septal hypertrophy)
ST-segment depression in lateral leads
Left axis deviation
May develop atrial fibrillation (with associated LVH voltage)

ECG Image — Apical HCM with Giant T-Wave Inversions

Apical hypertrophic cardiomyopathy ECG showing deep symmetric T-wave inversions

High QRS voltage (LVH) with deep, symmetric T-wave inversions in V3 — classic apical HCM (Yamaguchi) pattern.

ECG Image — HCM with Asymmetric Septal Hypertrophy

HCM ECG with high voltage QRS and deep T-wave inversions across precordial leads

LVH voltage with giant T inversions V2–V5 — characteristic of Yamaguchi/apical HCM. ST abnormalities in limb leads.

8. 🔥 Acute Pericarditis

ECG Changes (4 Stages)

Stage	Finding
Stage 1	Diffuse concave ST elevation (all leads except aVR/V1) + PR depression
Stage 2	ST returns to baseline, PR depression persists
Stage 3	T-wave inversions develop
Stage 4	Normalization

Key features: Saddle-shaped (concave) ST elevation in multiple leads (not one coronary territory), PR-segment depression (most specific sign), Spodick's sign (downsloping TP segment)
Reciprocal ST depression and PR elevation in aVR only
No pathological Q waves

ECG Image — Classic Pericarditis with PR Depression

Acute pericarditis ECG with diffuse saddle-shaped ST elevation and PR depression

Diffuse concave ST elevation in I, II, III, aVF, V2–V6. PR depression in II (most visible). Reciprocal ST depression + PR elevation in aVR. Spodick's sign present.

ECG Image — Pericarditis with Diffuse ST Changes

Pericarditis ECG showing widespread saddle-shaped ST elevation across multiple leads

Classic Stage 1 pericarditis — concave-upward ST elevation across multiple territories with PR depression in II, III, aVF, V4–V6.

9. 🧬 Brugada Syndrome

ECG Changes

Type 1 (diagnostic): Coved ST elevation ≥2 mm in V1–V2 (or V1–V3) with inverted T-wave — "coved" pattern
Type 2: Saddle-back ST elevation ≥0.5 mm in V1–V2 (not diagnostic alone)
Right bundle branch block morphology (may be incomplete)
Prolonged PR interval (first-degree AV block)
Spontaneous or provoked (by Na⁺-channel blockers, fever)
Associated with sudden cardiac death — risk of VF at rest/during sleep

ECG Image — Type 1 Brugada Pattern

Brugada syndrome Type 1 ECG with coved ST elevation in V1 and V2

Classic coved ST elevation ≥2 mm in V1 descending to inverted T-wave. Incomplete RBBB morphology in precordial leads — Type 1 Brugada (high-risk phenotype).

ECG Image — Brugada Spontaneous vs Drug-Provoked

Brugada syndrome comparison ECG showing spontaneous Type 1 and drug-unmasked pattern

Panel A (25-yr male): spontaneous Type 1 coved pattern in V1–V2. Panel B (36-yr male): RBBB at baseline → coved ST elevation unmasked by ajmaline (Na⁺-channel blocker challenge).

10. ⏱️ Long QT Syndrome (LQTS)

ECG Changes

Prolonged QTc — Males >440 ms; Females >460 ms (corrected using Bazett formula: QTc = QT/√RR)
Broad, notched, or bifid T-waves (LQT1: broad; LQT2: notched; LQT3: late-onset peaked T)
T-wave alternans — beat-to-beat variation in T-wave morphology/amplitude (high risk sign)
Torsades de Pointes (TdP) — polymorphic VT with "twisting" QRS axis around isoelectric line
May degenerate to VF and sudden cardiac death
Causes: congenital (KCNQ1, HERG, SCN5A mutations) or acquired (drugs, hypokalemia, hypomagnesemia)

ECG Image — Prolonged QTc with T-Wave Alternans

Long QT syndrome ECG with prolonged QTc and macro T-wave alternans

QTc 610 ms with macro T-wave alternans (beat-to-beat T-wave variation highlighted by red arrows in V2) — extremely high risk for TdP.

ECG Image — LQTS with Torsades de Pointes

Long QT syndrome ECG with prolonged QTc transitioning to torsades de pointes

Panel (a): Sinus rhythm with QTc 478 ms. Panel (b): Rhythm strips showing onset of Torsades de Pointes — polymorphic VT with characteristic "twisting" QRS morphology around the isoelectric baseline.

Quick Reference Summary Table

#	Condition	Key ECG Finding	Emergency?
1	STEMI	Convex ST elevation, Q waves, reciprocal changes	🚨 Yes — reperfusion <90 min
2	Atrial Fibrillation	Absent P waves, irregularly irregular	⚠️ Rate/rhythm control
3	AV Heart Block	PR prolongation → AV dissociation	🚨 3rd degree = pacemaker
4	VT / VF	Wide complex tachycardia / chaotic rhythm	🚨 Defibrillate VF immediately
5	WPW	Delta wave, short PR, wide QRS	⚠️ Avoid AV nodal blockers
6	Pulmonary Embolism	S1Q3T3, sinus tachycardia, RV strain	🚨 Anticoagulate/thrombolyze
7	HCM	LVH voltage, giant T-wave inversions	⚠️ SCD risk stratify
8	Pericarditis	Diffuse concave ST↑, PR depression	⚠️ NSAIDs + restrict activity
9	Brugada Syndrome	Coved ST elevation V1–V2, RBBB	⚠️ ICD if symptomatic
10	Long QT Syndrome	Prolonged QTc, TdP	🚨 Remove triggers, Mg²⁺, ICD

Clinical Pearl: Always interpret ECGs in clinical context — many patterns overlap. The S1Q3T3 of PE has low sensitivity (~20%) but high specificity when combined with tachycardia. Brugada pattern can be unmasked by fever or sodium-channel blockers. Pericarditis PR depression is the most specific differentiating sign from STEMI.

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