Explain me 10 common heart diseases with ECG Changes and ecg images of those diseases

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common heart diseases ECG changes with ECG images examples

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ECG images STEMI atrial fibrillation ventricular tachycardia heart block WPW pericarditis site:litfl.com OR site:ecgwaves.com

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ECG images atrial fibrillation STEMI complete heart block ventricular tachycardia pericarditis litfl.com

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STEMI ECG inferior anterior ventricular tachycardia WPW atrial flutter ECG image litfl.com

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ventricular tachycardia ECG hypertrophic cardiomyopathy ECG WPW delta wave ECG image site:litfl.com

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10 Common Heart Diseases with ECG Changes

Here is a comprehensive guide to 10 major cardiac conditions, their ECG findings, and reference images from medical textbooks and the LITFL ECG Library.

Quick ECG Reference Overview

Overview of killer ECG patterns including ARVD, Brugada, WPW, HCM, and pericardial effusion (LITFL ECG Library)

1. ST-Elevation Myocardial Infarction (STEMI)

Overview: STEMI results from complete occlusion of a coronary artery, causing transmural myocardial ischemia and necrosis.

ECG Changes:

Hyperacute T waves - the earliest finding, tall and peaked, in the affected leads
ST segment elevation ≥1 mm in 2+ contiguous limb leads or ≥2 mm in precordial leads
Pathological Q waves - develop after hours/days; represent electrically silent necrotic tissue (width >0.04s, depth >25% of R wave)
Reciprocal ST depression in mirror leads
T wave inversion in subacute/chronic phase

Localization by leads:

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

The mechanism: infarcted fibers rapidly repolarize and have decreased resting membrane potential. Both changes cause current flowing toward the infarcted zone, producing the hallmark ST elevation in overlying leads. - Ganong's Review of Medical Physiology, p. 534

ECG Image - Inferior STEMI ("tombstoning"):

Inferior STEMI with massive tombstone ST elevations

Inferior STEMI: massive tombstone ST elevations in II, III, aVF with reciprocal changes in I, aVL. (LITFL ECG Library)

2. Atrial Fibrillation (AF)

Overview: The most common sustained arrhythmia. Disorganized electrical activation of the atria leads to irregular ventricular response.

ECG Changes:

No discernible P waves - replaced by chaotic fibrillatory baseline (f waves, 350-600 bpm)
Irregularly irregular RR intervals - the hallmark finding
Variable ventricular rate (typically 100-180 bpm if uncontrolled)
Normal QRS morphology (unless aberrant conduction or pre-existing bundle branch block)
Fine (low voltage) or coarse (high voltage) fibrillatory baseline

The irregular rhythm arises because AV node conduction is random. At least 0.35 seconds must elapse between ventricular contractions, but the next fibrillatory impulse can arrive at any time, producing intervals varying from 0.35 to 0.95 seconds. - Guyton and Hall Textbook of Medical Physiology

ECG Image - Atrial Fibrillation:

Atrial Fibrillation ECG - irregularly irregular rhythm

AF (Lead II): no P waves, irregular QRS complexes. Ventricular QRS and T waves are visible; P waves replaced by fibrillatory baseline. (Guyton & Hall Textbook of Medical Physiology)

3. Atrial Flutter

Overview: A macro-reentrant atrial arrhythmia, typically with a right atrial circuit turning at ~300 bpm.

ECG Changes:

Sawtooth flutter waves at ~300 bpm (range 250-350 bpm) - best seen in II, III, aVF and V1
Regular atrial activity with negative flutter waves in inferior leads (II, III, aVF) in typical counterclockwise flutter
Ventricular rate = fraction of atrial rate: most commonly 2:1 block (150 bpm), can be 3:1, 4:1, or variable
No isoelectric baseline between flutter waves
QRS is usually narrow and normal unless aberrancy exists

ECG Image - Atrial Flutter with 2:1 block:

Atrial flutter with 2:1 AV conduction: sawtooth flutter waves clearly seen in inferior leads, ventricular rate ~150 bpm. (LITFL ECG Library)

4. Complete (3rd Degree) AV Heart Block

Overview: Complete failure of conduction from atria to ventricles. The atria and ventricles beat independently at their own rates.

ECG Changes:

Complete AV dissociation: P waves and QRS complexes are completely independent
Atrial rate > ventricular rate (e.g., P rate 70-100 bpm, ventricular escape 30-60 bpm)
Escape rhythm: junctional escape (narrow QRS, 40-60 bpm) or ventricular escape (wide QRS, 20-40 bpm)
Wide QRS if escape focus is ventricular (below His bundle)
No fixed PR interval relationship

Schematic diagram:

3rd degree heart block diagram showing P-R dissociation

Complete heart block: P waves (upward arrows) march through independently of QRS complexes (downward arrows). P rate > ventricular escape rate. (LITFL ECG Library)

Full 12-lead ECG - Complete Heart Block:

12-lead ECG in complete heart block: regular, slow ventricular escape rhythm with P waves marching through at a faster independent rate. (LITFL ECG Library)

5. Acute Pericarditis

Overview: Inflammation of the pericardial sac, typically viral, producing diffuse myocardial surface irritation.

ECG Changes (evolve through 4 stages):

Stage	Timing	ECG Finding
Stage 1	Hours-days	Diffuse concave-up (saddle-shaped) ST elevation in all leads except aVR and V1; PR depression in most leads; PR elevation in aVR
Stage 2	~1 week	ST and PR return to baseline; T wave flattening
Stage 3	After ST normalizes	Diffuse T wave inversion
Stage 4	Weeks-months	Normalization (or persistent T inversion)

Key distinguishing points from STEMI: ST elevation is diffuse (not regional), concave up (not convex), and accompanied by PR depression. Reciprocal ST depression is absent except in aVR/V1.

ECG Image - Acute Pericarditis:

Pericarditis ECG showing diffuse ST elevation and PR depression

Acute pericarditis: diffuse concave ST elevation across multiple leads with PR depression - classic saddle shape. (LITFL ECG Library)

6. Wolff-Parkinson-White (WPW) Syndrome

Overview: Pre-excitation syndrome caused by an accessory pathway (Bundle of Kent) that bypasses the AV node and conducts impulses faster, causing early ventricular activation (pre-excitation).

ECG Changes (in sinus rhythm):

Short PR interval <120 ms (no AV nodal delay)
Delta wave - slurred upstroke at the beginning of the QRS, representing pre-excitation of ventricular myocardium
Wide QRS >120 ms (total QRS = delta + normal activation)
Secondary ST-T changes discordant to QRS direction
Pseudo-infarct pattern possible (mimics Q waves)

During tachyarrhythmias (AF with WPW):

Extremely rapid ventricular rate (>200 bpm), potentially fatal
Irregularly irregular, wide, and bizarre QRS complexes
Risk of VF

ECG Image - AF in WPW (pre-excited AF):

WPW with Atrial Fibrillation ECG - pre-excited AF

AF in WPW: chaotic, extremely rapid, irregularly irregular, wide QRS complexes - a life-threatening arrhythmia. Rate well above 200 bpm. (LITFL ECG Library)

7. Ventricular Tachycardia (VT)

Overview: Three or more consecutive ventricular beats at >100 bpm originating below the bundle of His. Can be monomorphic (uniform QRS) or polymorphic.

ECG Changes:

Wide QRS >120 ms (usually >140 ms)
Regular rhythm, typically 100-250 bpm
AV dissociation - P waves march through independently (seen in ~50% of cases)
Fusion beats - partial activation from sinus + VT origin (pathognomonic)
Capture beats - rare sinus captures that produce narrow QRS (pathognomonic)
Extreme axis deviation
Concordance in precordial leads (all positive or all negative)

Brugada criteria help distinguish VT from SVT with aberrancy:

Absence of RS in all precordial leads → VT
RS interval >100 ms in any precordial lead → VT
AV dissociation → VT
Morphology criteria not met for SVT → VT

The VT ECG (see Atrial Flutter 12-lead above as context) and the Killer Rhythms infographic above show the wide complex morphology.

8. Hypertrophic Cardiomyopathy (HCM)

Overview: Genetic cardiomyopathy with asymmetric myocardial hypertrophy (typically interventricular septum). Leading cause of sudden cardiac death in young athletes.

ECG Changes:

Left ventricular hypertrophy (LVH) voltage criteria: SV1 + RV5/V6 >35 mm (Sokolow-Lyon)
Deep, narrow Q waves ("dagger Q waves") in lateral leads (I, aVL, V5-V6) and inferior leads - due to septal hypertrophy
T wave inversion - widespread, often striking
Left axis deviation
ST depression in lateral leads
Apical HCM pattern: giant T wave inversions in precordial leads (V3-V5), up to 10-15 mm deep

ECG Image - HCM:

Hypertrophic Cardiomyopathy ECG with LVH and dagger Q waves

HCM ECG: LVH, deep Q waves in lateral leads, widespread ST depression and T wave inversion. (LITFL ECG Library)

9. Brugada Syndrome

Overview: Inherited sodium channelopathy causing life-threatening ventricular arrhythmias and sudden cardiac death, often in young males, often during sleep.

ECG Changes (Type 1 is diagnostic):

Type	Pattern	Diagnostic?
Type 1	Coved ST elevation ≥2 mm in V1-V3, descending into negative T wave	Yes
Type 2	Saddleback ST elevation ≥2 mm in V1-V3, positive T wave	Requires provocation
Type 3	ST elevation <1 mm, either coved or saddle	Not diagnostic

Additional features:

Right bundle branch block (RBBB) pattern
Spontaneously fluctuating pattern
PR prolongation in some cases

The Killer Rhythms infographic at the top of this article clearly shows the coved ST elevation >2mm and negative T wave in V1-3 - the diagnostic hallmark.

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

Overview: Dilated, poorly contracting ventricle with widespread myocardial damage. Common end-stage of multiple heart diseases.

ECG Changes (non-specific but characteristic):

Left bundle branch block (LBBB): broad QRS >120 ms, broad notched R in I, aVL, V5-V6; deep S in V1; ST-T discordant changes
Left ventricular hypertrophy voltage criteria
Poor R wave progression in precordial leads (V1-V4)
Pathological Q waves if ischemic etiology
Atrial fibrillation - frequently superimposed
Left axis deviation
Prolonged QRS (>120 ms) - indicates dyssynchrony, marker for CRT benefit
Sinus tachycardia in decompensated state
Low voltage QRS if large pericardial effusion coexists

Summary Table

#	Condition	Key ECG Hallmark	Rate	Rhythm
1	STEMI	ST elevation + Q waves (regional)	Variable	Regular
2	Atrial Fibrillation	No P waves, irregularly irregular	100-180	Irregular
3	Atrial Flutter	Sawtooth flutter waves (~300 bpm)	150 (2:1)	Regular
4	Complete AV Block	P-QRS dissociation, escape rhythm	30-60	Regular
5	Pericarditis	Diffuse concave ST↑, PR depression	Normal	Regular
6	WPW	Delta wave, short PR, wide QRS	Variable	Variable
7	Ventricular Tachycardia	Wide QRS, AV dissociation, fusion beats	100-250	Regular
8	HCM	Dagger Q waves, deep T inversion, LVH	Normal	Regular
9	Brugada Syndrome	Coved ST elevation V1-V3	Normal	Regular
10	DCM/Heart Failure	LBBB, poor R progression, AF	Variable	Variable

Sources:

Guyton and Hall Textbook of Medical Physiology (Atrial fibrillation ECG, p. ~1775-1783)
Ganong's Review of Medical Physiology, 26th Ed. (Myocardial infarction ECG, p. 534)
LITFL ECG Library - Burns & Buttner (ECG images used under CC BY-NC-SA 4.0)
ESC Guidelines on Pericarditis (ESCardioj.org)

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Heart Diseases ECG Guide

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What's inside (2.6 MB, A4 format):

Cover page with the full summary table and LITFL Killer ECG infographic
10 disease sections, each with:
- Colour-coded section header
- Clinical overview
- Structured ECG changes table (feature + detailed explanation)
- Annotated real ECG images (STEMI, AF, Atrial Flutter, Complete Heart Block, Pericarditis, WPW with AF, HCM)
- Key clinical notes
Final summary page with all 10 diseases at a glance (key hallmark, rate, rhythm)
Sources cited from Guyton & Hall, Ganong's, Harrison's, Braunwald's, and LITFL ECG Library

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Document details: 1.56 MB, 35 internal parts

What's inside:

Cover page - title banner, intro text, LITFL Killer ECG infographic, full 10-disease summary table
10 disease sections, each with:
- Colour-coded section header (each disease has a unique colour)
- Overview paragraph
- Structured ECG changes table (feature + detailed explanation, alternating row shading)
- Clinical notes
- Real ECG images embedded for: STEMI, AF, Atrial Flutter, Complete Heart Block, Pericarditis, WPW with AF, and HCM
Final summary page with the complete at-a-glance table
Running header (title + "Orris Medical Reference") and page-numbered footer on every page
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What's in the file (34 KB, fully self-contained):

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10 colour-coded disease cards with ECG change tables + embedded ECG images (loaded from LITFL)
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