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Top 10 heart diseases with ecg finding

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ECG electrocardiogram heart disease findings

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atrial fibrillation ECG tracing

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STEMI inferior myocardial infarction ST elevation ECG

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hypertrophic cardiomyopathy ECG left ventricular hypertrophy

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complete heart block third degree AV block ECG

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pericarditis saddle shape ST elevation ECG

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

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long QT syndrome Brugada syndrome ventricular tachycardia ECG

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dilated cardiomyopathy heart failure ECG left bundle branch block

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Top 10 Heart Diseases with ECG Findings

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Findings:
  • ST-segment elevation ≥1 mm in ≥2 contiguous limb leads or ≥2 mm in precordial leads
  • Tombstone/convex (upwardly domed) morphology of ST segment
  • Reciprocal ST depression in mirror leads (e.g., elevation in II, III, aVF → depression in I, aVL)
  • Hyperacute T waves (early phase)
  • Pathological Q waves (>40 ms wide, >25% of R-wave height) develop within hours
  • T-wave inversion in the evolutionary phase
Territory Localisation:
TerritoryLeads with ST elevationArtery
InferiorII, III, aVFRCA / LCx
AnteriorV1–V4LAD
LateralI, aVL, V5–V6LCx
PosteriorST depression V1–V3 (reciprocal)RCA
Inferior STEMI ECG

2. 💓 Atrial Fibrillation (AF)

ECG Findings:
  • Absence of P waves — replaced by fine, chaotic fibrillatory (f) waves (most visible in V1)
  • Irregularly irregular RR intervals — hallmark finding
  • Narrow QRS (unless aberrant conduction or bundle branch block present)
  • Ventricular rate varies (typically 100–160 bpm if uncontrolled)
Atrial Fibrillation ECG
Source: Guyton and Hall Textbook of Medical Physiology; Tintinalli's Emergency Medicine

3. 🏋️ Hypertrophic Cardiomyopathy (HCM)

ECG Findings:
  • Left ventricular hypertrophy (LVH) voltage criteria — deep S in V1 + tall R in V5/V6 ≥35 mm (Sokolow-Lyon)
  • Narrow septal Q waves in lateral leads (V5, V6, I, aVL) — due to septal hypertrophy
  • T-wave upright in leads with septal Q waves (unlike ischemia)
  • Apical HCM: giant deep symmetric T-wave inversions in V2–V5 (Yamaguchi pattern)
  • ST-segment depression (strain pattern)
  • May show atrial arrhythmias (AF, flutter)
HCM ECG — deep S wave, septal Q waves, apical variant with giant T inversions
Source: Tintinalli's Emergency Medicine — "Deep S-wave voltage (28 mm S in V3), narrow septal Q waves in V5 and V6 are noted."

4. 🔌 Complete (Third-Degree) AV Block

ECG Findings:
  • Complete AV dissociation — P waves and QRS complexes bear no fixed relationship
  • P waves march through QRS complexes and T waves at a faster independent rate
  • Escape rhythm maintains ventricular activity:
    • Junctional escape: narrow QRS, rate 40–60 bpm
    • Ventricular escape: wide QRS (>120 ms), rate 20–40 bpm
  • Regular P-P and R-R intervals, but PR interval varies randomly
Complete Heart Block ECG

5. 🔥 Acute Pericarditis

ECG Findings (4 stages):
  • Stage 1 (days): Diffuse concave (saddle-shaped) ST elevation in nearly all leads EXCEPT aVR and V1 (reciprocal ST depression); PR-segment depression (most visible in II, V4–V6); PR elevation in aVR — pathognomonic
  • Spodick's sign: downward sloping TP segment
  • Stage 2: ST normalises, T waves flatten
  • Stage 3: T-wave inversion
  • Stage 4: ECG normalises
Key distinction from STEMI: diffuse (not territorial), concave ST morphology, PR depression, no Q waves
Pericarditis ECG — saddle ST elevation, PR depression

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

ECG Findings (pre-excitation triad):
  1. Short PR interval (<120 ms) — accessory pathway bypasses AV node
  2. Delta wave — slurred initial upstroke of QRS (slow conduction through accessory pathway)
  3. Wide QRS (>120 ms) — fusion of delta wave + normal conduction
  • Secondary ST-T changes discordant to QRS (not primary ischemia)
  • Pseudo-infarct Q waves in inferior/lateral leads (negative delta waves mimicking Q waves)
  • Risk of rapid pre-excited AF → ventricular fibrillation
WPW ECG — short PR, delta waves, wide QRS

7. 💔 Dilated Cardiomyopathy (DCM) / Heart Failure with Reduced EF

ECG Findings:
  • Left Bundle Branch Block (LBBB) — most characteristic: QRS >120 ms, broad monophasic R in I/V5/V6, deep S (QS) in V1–V3
  • Poor R-wave progression across precordial leads
  • First-degree AV block (PR >200 ms)
  • Low voltage QRS (suggests co-existent pericardial effusion or amyloid)
  • Left axis deviation
  • Atrial arrhythmias (AF common)
  • Non-specific ST-T changes
Dilated Cardiomyopathy with LBBB ECG

8. 📏 Long QT Syndrome (LQTS)

ECG Findings:
  • Prolonged QTc interval: ≥450 ms (males), ≥460 ms (females); ≥500 ms is high risk
  • T-wave morphology varies by subtype:
    • LQT1: Broad-based T waves
    • LQT2: Notched/bifid T waves (low amplitude, jagged)
    • LQT3: Late-peaking, peaked T waves with long isoelectric ST
  • Prominent U waves (LQT1, drug-induced)
  • T-wave alternans — beat-to-beat T-wave variation; marker of high arrhythmia risk
  • Torsades de Pointes: polymorphic VT with "twisting" QRS morphology around isoelectric line — initiated by short-long-short RR sequence
Long QT Syndrome with Torsades de Pointes
Source: Harrison's Principles of Internal Medicine 22E

9. 🧬 Brugada Syndrome

ECG Findings:
  • Type 1 (diagnostic): Coved-type ST elevation ≥2 mm in ≥1 of V1–V2 with right bundle branch block (RBBB) morphology, followed by negative T wave (no isoelectric separation)
  • Type 2: Saddle-back ST elevation ≥2 mm (V1–V2), positive/biphasic T wave (not diagnostic alone)
  • Type 3: ST elevation <1 mm
  • Incomplete RBBB morphology
  • May unmask with fever, sodium channel blockers (ajmaline test)
  • Substrate for polymorphic VT/VF and sudden cardiac death

10. 🩸 Cardiac Amyloidosis

ECG Findings (classic combination):
  • Low voltage QRS despite echocardiographic LVH ("voltage-mass mismatch" — hallmark)
    • QRS amplitude <5 mm in all limb leads, <10 mm in precordial leads
  • Pseudo-infarct pattern — pathological Q waves in anterior or inferior leads without true coronary occlusion
  • AF — very common (50%+ of patients)
  • First-degree and higher-degree AV block
  • Left axis deviation
  • Poor R-wave progression
Cardiac Amyloidosis — low voltage AF ECG

Summary Table

#DiseaseKey ECG Finding(s)
1STEMIST elevation (convex), reciprocal changes, Q waves
2Atrial FibrillationAbsent P waves, irregularly irregular RR
3Hypertrophic CardiomyopathyLVH voltage, septal Q waves, giant T inversions (apical)
4Complete AV BlockAV dissociation, P waves independent of QRS
5Acute PericarditisDiffuse concave ST elevation, PR depression, saddle shape
6WPW SyndromeShort PR, delta wave, wide QRS (pre-excitation triad)
7Dilated CardiomyopathyLBBB, poor R progression, low voltage
8Long QT SyndromeProlonged QTc, notched T waves, Torsades de Pointes
9Brugada SyndromeCoved ST elevation V1–V2, RBBB morphology
10Cardiac AmyloidosisLow voltage + LVH paradox, pseudo-infarct Q waves, AF
Sources: Tintinalli's Emergency Medicine; Braunwald's Heart Disease; Harrison's Principles of Internal Medicine 22E; Fuster and Hurst's The Heart 15th Ed; Guyton and Hall Textbook of Medical Physiology; Goldman-Cecil Medicine.
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