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common heart disease ECG patterns STEMI atrial fibrillation heart block complete ECG strip images

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STEMI ST elevation myocardial infarction ECG graph image site:litfl.com OR site:ecglibrary.com

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Here is a thorough guide to the most common heart diseases and their ECG patterns, with real ECG graphs.

Common Heart Diseases and Their ECG Findings

ECG Quick Reference - Generated Diagram

ECG Pattern Reference Chart (from Life in the Fast Lane ECG Library)

Common Arrhythmias - ECG Strips

The image below shows real ECG tracings for 5 major arrhythmias:

Common Arrhythmia ECG strips - 2nd degree block, AF, VT, VF, 3rd degree block

1. Normal Sinus Rhythm (Baseline)

Rate: 60-100 bpm | Rhythm: Regular

Regular P wave before every QRS
PR interval: 0.12-0.20 sec
QRS duration: <0.12 sec
Normal T wave following QRS

2. ST-Elevation Myocardial Infarction (STEMI) - Heart Attack

The most critical ECG emergency

Key ECG Features:

ST elevation ≥1mm in ≥2 contiguous limb leads, or ≥2mm in precordial leads
"Tombstone" or "hyperacute" T wave appearance in early phase
Pathological Q waves develop within hours (>40ms wide, >25% of R wave height)
Reciprocal ST depression in opposite leads

Localisation by leads:

Territory	Leads with ST elevation	Artery
Anterior	V1-V4	LAD
Inferior	II, III, aVF	RCA
Lateral	I, aVL, V5-V6	LCx
Posterior	V7-V9 (ST depression V1-V3)	RCA/LCx

3. Atrial Fibrillation (AF)

Most common sustained arrhythmia - affects ~1% of population

Key ECG Features:

Absent P waves - replaced by chaotic fibrillatory baseline (f-waves)
Irregularly irregular RR intervals (no pattern at all)
Ventricular rate 100-160 bpm if uncontrolled
Narrow QRS complexes (unless aberrant conduction)

Clinical significance: Risk of stroke (thrombus formation in left atrial appendage), needs anticoagulation assessment using CHA₂DS₂-VASc score.

4. Ventricular Tachycardia (VT)

Life-threatening - requires immediate treatment

Key ECG Features:

Wide QRS complexes (>0.12 sec, usually >0.14 sec) - bizarre morphology
Rate 150-250 bpm
AV dissociation - P waves march through independently (seen in ~50% of cases)
Fusion beats and capture beats (pathognomonic of VT)
Concordance in precordial leads (all positive or all negative)

5. Ventricular Fibrillation (VF)

Cardiac arrest - no cardiac output

Key ECG Features:

Completely chaotic electrical activity - no recognizable P, QRS, or T waves
Rapid irregular undulations of varying amplitude
No organized rhythm whatsoever
Requires immediate defibrillation

6. Complete (Third-Degree) AV Block

Key ECG Features:

Complete AV dissociation - P waves and QRS complexes bear NO relationship to each other
P waves march at their own rate (usually 60-100 bpm)
QRS complexes march at their own slower escape rate (20-40 bpm if ventricular, 40-60 if junctional)
Broad QRS if escape rhythm is ventricular in origin
Patient is severely bradycardic - requires pacing

7. Second-Degree AV Block

Two types:

Mobitz I (Wenckebach): PR interval progressively lengthens until a QRS is dropped, then resets
Mobitz II: Constant PR interval with sudden non-conducted P waves (more dangerous, often requires pacing)

8. Left Bundle Branch Block (LBBB)

Key ECG Features:

Broad QRS >0.12 sec (usually >0.14 sec)
"WiLLiaM" pattern: W shape in V1, M shape in V5/V6
Broad, notched R waves in I, aVL, V5-V6
Deep S waves in V1-V3
No septal Q waves in lateral leads
New LBBB in the context of chest pain = treat as STEMI equivalent

9. Wolff-Parkinson-White (WPW) Syndrome

Pre-excitation syndrome

Key ECG Features:

Short PR interval (<0.12 sec) - due to bypassing the AV node
Delta wave - slurred upstroke at the beginning of QRS
Broad QRS complex
Can cause supraventricular tachycardia (SVT) or dangerous AF with rapid conduction

10. Brugada Syndrome

Channelopathy - cause of sudden cardiac death in young people

Key ECG Features (V1-V3):

Coved-type ST elevation >2mm in V1-V3 (Type 1 - diagnostic)
Followed by a negative T wave
Can be unmasked by fever, flecainide, or sodium channel blockers
Risk of VF and sudden death - managed with ICD implantation

11. Left Ventricular Hypertrophy (LVH)

Key ECG Features:

High voltage QRS - Sokolov-Lyon criterion: S in V1 + R in V5/V6 >35mm
Left axis deviation
ST depression and T wave inversion in lateral leads (strain pattern)
Seen in long-standing hypertension, aortic stenosis, HCM

12. Pericarditis

Key ECG Features (evolve in stages):

Stage 1: Diffuse saddle-shaped ST elevation in almost all leads + PR depression
Stage 2: ST returns to baseline, T waves flatten
Stage 3: T wave inversion
Stage 4: Normalization
Key: Widespread ST elevation (not in a coronary territory) distinguishes it from STEMI

Quick Summary Table

Condition	Rate	P waves	QRS	Hallmark feature
Normal	60-100	Present, regular	Narrow	Baseline
STEMI	Variable	Present	Narrow	ST elevation + Q waves
Atrial Fibrillation	100-160	Absent (f-waves)	Narrow	Irregularly irregular
VT	150-250	Dissociated	Wide	AV dissociation
VF	-	None	None	Chaotic waveform
3rd degree block	20-60	Present, regular	Wide/Narrow	P-QRS dissociation
LBBB	Normal	Present	Wide	WiLLiaM pattern
WPW	Normal	Present	Wide	Delta wave + short PR
Brugada	Normal	Present	Normal	Coved ST V1-V3
LVH	Normal	Present	Tall	High voltage + strain
Pericarditis	Normal	Present	Narrow	Diffuse saddle ST elevation

Sources: Braunwald's Heart Disease (Textbook of Cardiovascular Medicine), Life in the Fast Lane ECG Library, Geeky Medics ECG Guide. ECG interpretation should always be correlated with the clinical picture.

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