Explain me 10 common heart disease with ecg changes and ecg images of those disease

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ECG electrocardiogram myocardial infarction ST elevation STEMI

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ECG atrial fibrillation irregular rhythm absent P waves

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ECG heart block third degree complete AV block

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ECG hypertrophic cardiomyopathy left ventricular hypertrophy

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

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ECG pulmonary embolism S1Q3T3 right heart strain

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ECG ventricular tachycardia wide complex tachycardia

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ECG pericarditis diffuse ST elevation saddle shape PR depression

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ECG left bundle branch block LBBB wide QRS

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ECG hyperkalemia peaked T waves sine wave pattern

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

10 Common Heart Diseases: ECG Changes & Images

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

ECG Changes

Phase	Finding
Hyperacute	Tall, peaked (hyperacute) T-waves
Acute	ST-segment elevation ≥1 mm (≥2 mm in V1–V4), convex "tombstone" morphology
Evolving	Pathological Q waves (>40 ms wide, >25% of R-wave height)
Reciprocal	ST depression in leads opposite the infarct zone
Chronic	Q waves persist; T-wave inversion

Territory localization:

Anterior (LAD): ST elevation in V1–V4
Inferior (RCA): ST elevation in II, III, aVF; reciprocal depression in I, aVL
Lateral (LCx): ST elevation in I, aVL, V5–V6
Posterior: ST depression in V1–V3 + tall R waves

ECG Images

Anterior STEMI – tombstoning in V2–V5, LAD occlusion

Anterior STEMI: pronounced "tombstone" ST elevation in V2–V5, evolving QS waves, consistent with proximal LAD occlusion

Anterolateral STEMI with reciprocal changes in inferior leads

Anterolateral STEMI: ST elevation V1–V6 + leads I and aVL with reciprocal ST depression in II, III, aVF

Inferolateral STEMI with annotated ST elevation and reciprocal changes

Inferolateral STEMI: ST elevation in II, III, aVF, V4–V6 (green circles) with reciprocal depressions in I, aVL, V2–V3 (yellow arrows)

2. ❤️‍🔥 Atrial Fibrillation (AF)

ECG Changes

Feature	Finding
P waves	Absent — replaced by chaotic fibrillatory (f) waves at 350–600/min
Rhythm	Irregularly irregular R-R intervals (hallmark)
Rate	Variable; uncontrolled: 100–160 bpm
QRS	Narrow (unless aberrant conduction or pre-excitation)
Baseline	Fine or coarse fibrillatory activity, best seen in V1

ECG Image

Atrial fibrillation – absent P waves, irregularly irregular rhythm with RVR

AF with rapid ventricular response (~134 bpm): absent P waves, chaotic baseline, irregularly irregular QRS complexes with narrow morphology

3. 🚫 Complete (Third-Degree) AV Block

ECG Changes

Feature	Finding
AV dissociation	Complete — P waves and QRS bear NO relationship
P waves	Regular at faster atrial rate (e.g., 75 bpm)
QRS rate	Slow escape rhythm (20–45 bpm if ventricular; 40–60 bpm if junctional)
QRS width	Wide (>120 ms) if ventricular escape; narrow if junctional
PR interval	No fixed PR interval — P waves "march through" QRS complexes

ECG Images

Complete AV block – 12-lead with wide-complex ventricular escape

Third-degree heart block: wide-complex escape rhythm, P waves dissociated from QRS complexes, postoperative tricuspid valve replacement

Complete heart block – narrow-complex junctional escape, slow rate ~36 bpm

Third-degree AV block with narrow-complex junctional escape at ~36 bpm — pacemaker implantation indicated

4. 🏋️ Hypertrophic Cardiomyopathy (HCM)

ECG Changes

Feature	Finding
LVH	Sokolow-Lyon criteria: S in V1 + R in V5/V6 >35 mm
ST-T changes	Diffuse ST depression + deep T-wave inversions (strain pattern)
Apical HCM	Giant T-wave inversions in V3–V5 (Yamaguchi syndrome) — ≥10 mm deep
Septal Q waves	Absent in I, aVL, V5–V6 (due to abnormal septal depolarization)
QRS axis	Left axis deviation common
Arrhythmias	AF, ventricular ectopy, non-sustained VT

ECG Images

HCM comparison – concentric, septal, and apical variants with CMR correlation

HCM variants: (A) Concentric — high-voltage R waves + strain; (B) Septal — moderate LVH; (C) Apical — giant T-wave inversions (12 mm) in lateral leads, with CMR correlation

Apical HCM – giant symmetric T-wave inversions V2–V5 (Yamaguchi syndrome)

Apical HCM (Yamaguchi syndrome): high-voltage QRS + dramatic deep symmetric T-wave inversions in V2–V5

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

ECG Changes

Feature	Finding
PR interval	Short (<120 ms) — bypass tract bypasses AV node delay
Delta wave	Slurred upstroke of the QRS — hallmark of pre-excitation
QRS width	Widened (>120 ms)
ST-T changes	Discordant (opposite to QRS vector) — secondary repolarization changes
Pseudo-infarct	Negative delta waves in II, III, aVF can mimic inferior Q waves
Arrhythmia risk	AVRT, AF with rapid ventricular response (potentially fatal)

Pathway localization: Delta wave polarity in V1 and inferior leads identifies pathway location (left lateral, posteroseptal, anteroseptal, etc.)

ECG Images

WPW with red arrows marking delta waves in leads II and III – anteroseptal pathway

WPW syndrome: short PR, widened QRS with delta waves (red arrows in II and III), regular tachycardia — anteroseptal accessory pathway

WPW – classic delta waves, short PR, secondary ST-T changes

WPW: Short PR (<120 ms), widened QRS with prominent delta waves across precordial and lateral limb leads, mid-septal pathway location

6. 🫁 Pulmonary Embolism (PE)

ECG Changes

Feature	Finding
Sinus tachycardia	Most common ECG finding (~40% of PE)
S1Q3T3 pattern	Deep S in lead I + Q wave in III + T-wave inversion in III (McGinn-White sign)
Right axis deviation	Reflecting acute RV strain
RBBB	New complete or incomplete right bundle branch block
T-wave inversions	V1–V4 (right precordial) indicating RV strain
P pulmonale	Tall, peaked P waves in II if severe pulmonary hypertension

⚠️ ECG is non-specific; normal ECG does not rule out PE. Always correlate with clinical probability and CT-PA.

ECG Images

PE – S1Q3T3 pattern with annotated arrows

Acute PE: S1Q3T3 pattern with annotated black circles — deep S in I, Q in III, T-wave inversion in III; sinus tachycardia

PE with S1Q3T3 + incomplete RBBB + T-wave inversions V1–V3

Acute PE: S1Q3T3 pattern + incomplete RBBB (QRS 110 ms) + T-wave inversions in V1–V3 and aVF — consistent with acute right ventricular strain

7. 💥 Ventricular Tachycardia (VT)

ECG Changes

Feature	Finding
Rate	100–250 bpm
QRS	Wide (>120 ms), bizarre morphology
Rhythm	Regular (monomorphic VT) or irregular (polymorphic/torsades)
P waves	Absent or dissociated from QRS (AV dissociation)
Fusion beats	Narrow QRS "capture" or hybrid beats = pathognomonic for VT
Concordance	All precordial leads positive or negative = strongly suggests VT
Brugada criteria	RS absent in precordials, RS >100 ms, AV dissociation, morphology criteria

ECG Image

Monomorphic VT – wide complex tachycardia, no P waves, positive concordance

Monomorphic VT: rapid wide-complex tachycardia, positive precordial concordance, no discernible P waves — associated with structural heart disease

Left fascicular VT – RBBB morphology + left axis deviation (Belhassen VT)

Left fascicular VT (Belhassen): RBBB morphology + left axis deviation — idiopathic, verapamil-sensitive form; typically younger patients without structural disease

8. 🔥 Acute Pericarditis

ECG Changes (4 Stages)

Stage	Finding
Stage I (hours–days)	Diffuse concave ("saddle-shaped") ST elevation in all leads except aVR and V1; PR depression in II + PR elevation in aVR
Stage II (1–3 weeks)	ST normalizes; T waves flatten
Stage III	Diffuse T-wave inversion
Stage IV	ECG normalizes

Key differentiators from STEMI:

Diffuse (not territory-specific) ST elevation
Concave (not convex/tombstone) morphology
PR segment depression
Spodick's sign: downsloping TP segment
No reciprocal changes (except aVR)

ECG Images

Pericarditis – diffuse saddle-shaped ST elevation + PR depression in multiple leads

Acute pericarditis: concave ST elevation in I, II, III, aVF, V2–V6; PR depression in II; reciprocal ST depression + PR elevation in aVR; Spodick's sign present

Pericarditis – diffuse concave ST elevation + PR segment changes annotated

Pericarditis Stage I: saddle-shaped ST elevation across multiple territories, PR depression in II, III, aVF, V4–V6, reciprocal PR elevation in aVR — no Q waves

9. 🔀 Left Bundle Branch Block (LBBB)

ECG Changes

Feature	Finding
QRS duration	≥120 ms (complete LBBB)
V1	Deep broad QS or rS pattern
I, aVL, V5–V6	Broad, notched M-shaped (bifid) R waves — no Q waves
ST-T discordance	ST/T-wave changes opposite to QRS direction
Lateral T-waves	T-wave inversion in I, aVL, V5–V6
No septal Q waves	Absent in lateral leads
Clinical significance	New LBBB in ACS = treat as STEMI equivalent (Sgarbossa criteria)

ECG Images

Classic LBBB – broad M-shaped R in lateral leads, deep QS in V1, discordant T waves

Classic LBBB: wide QRS >120 ms, notched M-shaped R waves in I, aVL, V5–V6; deep broad S in V1–V3; T-wave discordance (upright in V1–V3, inverted laterally)

LBBB with Sgarbossa criteria – discordant STE in V1–V3, helps detect underlying STEMI

LBBB with discordant ST elevation in V1–V3 and ST depression in I, aVL, V6 — Sgarbossa criterion: discordant STE ≥1 mm is expected, but concordant STE suggests underlying ischemia

10. ⚗️ Hyperkalemia

ECG Changes (Progressive with rising K⁺)

Serum K⁺	ECG Finding
5.5–6.5 mEq/L	Tall, narrow-based "tented" peaked T waves (earliest sign, best in V2–V4)
6.5–7.5 mEq/L	Prolonged PR interval, flattening/loss of P waves
7.5–8.0 mEq/L	Widened QRS (intraventricular conduction delay)
>8.0 mEq/L	Sine-wave pattern (fusion of QRS and T), ventricular fibrillation, asystole

⚠️ Hyperkalemia is a medical emergency. Give IV calcium gluconate immediately when ECG changes are present to stabilize the myocardial membrane.

ECG Images

Early hyperkalemia – tall peaked tented T waves in V2–V4 with K⁺ 7.3 mEq/L

Hyperkalemia (K⁺ = 7.3 mEq/L): classic tall, narrow-based peaked T waves in V2–V4 (blue arrows) — earliest ECG sign, no QRS widening yet at this stage

Severe hyperkalemia – QRS widening, peaked T waves, approaching sine-wave pattern

Severe hyperkalemia: broad-complex tachycardia at ~126 bpm with sine-wave QRS morphology, peaked T waves in V2–V4, absent P waves — pre-arrest state

Quick Reference Summary Table

#	Condition	Key ECG Finding
1	STEMI	ST elevation + Q waves in territory; reciprocal depression
2	Atrial Fibrillation	Absent P waves + irregularly irregular rhythm
3	Complete AV Block	P-QRS dissociation + slow escape rhythm
4	HCM	LVH voltage + giant T-wave inversions (apical)
5	WPW	Short PR + delta wave + widened QRS
6	Pulmonary Embolism	S1Q3T3 + sinus tachycardia + right heart strain
7	Ventricular Tachycardia	Wide QRS tachycardia + AV dissociation
8	Pericarditis	Diffuse saddle-shaped ST elevation + PR depression
9	LBBB	Wide QRS + notched R in I/V5–V6 + ST discordance
10	Hyperkalemia	Peaked T waves → QRS widening → sine wave

Sources: Harrison's Principles of Internal Medicine 22E; Tintinalli's Emergency Medicine; Ganong's Review of Medical Physiology; ROSEN's Emergency Medicine — ECG images from peer-reviewed PMC literature.

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