Explain 10 common heart diseases with ECG changes and ecg inages of those diseases

Reading File

Finding Sources

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ECG electrocardiogram myocardial infarction ST elevation

Finding Sources

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atrial fibrillation ECG irregularly irregular rhythm

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heart block complete AV block ECG bradycardia

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ventricular tachycardia ECG wide complex tachycardia

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hypertrophic cardiomyopathy ECG left ventricular hypertrophy

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pulmonary embolism ECG S1Q3T3 right heart strain

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Wolff-Parkinson-White syndrome delta wave short PR ECG

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pericarditis ECG saddle-shaped ST elevation diffuse

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dilated cardiomyopathy ECG left bundle branch block low voltage

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long QT syndrome torsades de pointes ECG polymorphic ventricular tachycardia

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

10 Common Heart Diseases: ECG Changes & Images

1. 🫀 ST-Elevation Myocardial Infarction (STEMI)

What it is

Acute complete occlusion of a coronary artery causing full-thickness myocardial injury. Most commonly involves the LAD (anterior), RCA (inferior), or LCx (lateral) territory.

ECG Changes

Feature	Finding
ST Segments	Convex (tombstone) ST elevation ≥1 mm in ≥2 contiguous leads
Reciprocal Changes	ST depression in leads opposite to the infarct territory
Hyperacute T-waves	Tall, peaked T-waves in the early phase
Q-waves	Pathological Q-waves develop within hours (>40 ms wide, >25% of R-wave height)
T-wave inversions	Follow ST elevation in the evolutionary phase

Localisation:

Anterior (V1–V4) → LAD occlusion
Inferior (II, III, aVF) → RCA occlusion
Lateral (I, aVL, V5–V6) → LCx occlusion

ECG Image — Anterior STEMI (LAD territory)

Anterior STEMI ECG showing ST elevation in V1-V6

ECG Image — Inferolateral STEMI

Inferolateral STEMI with ST elevation in inferior and lateral leads with reciprocal changes

2. ❤️ Atrial Fibrillation (AF)

What it is

The most common sustained cardiac arrhythmia, caused by chaotic electrical activity in the atria (often originating from pulmonary vein triggers). Associated with hypertension, valvular disease, heart failure, hyperthyroidism, and alcohol use.

ECG Changes

Feature	Finding
P waves	Absent; replaced by fine, irregular fibrillatory (f) waves at 350–600/min
Rhythm	"Irregularly irregular" ventricular response
QRS complex	Narrow (unless aberrant conduction or WPW co-exists)
Rate	Ventricular rate 60–180/min depending on AV node conduction
Baseline	Undulating, no flat isoelectric line

ECG Image

12-lead ECG showing atrial fibrillation with absent P waves and irregularly irregular rhythm

3. 🔵 Complete (Third-Degree) AV Block

What it is

Complete failure of AV conduction — no atrial impulses reach the ventricles. The atria and ventricles beat independently. Caused by inferior MI, fibrosis of the conduction system, medications, or infiltrative disease.

ECG Changes

Feature	Finding
AV Dissociation	P waves and QRS complexes completely independent
Atrial Rate	Regular, usually 60–100/min
Ventricular Rate	Slow escape rhythm: 40–60/min (nodal) or 20–40/min (ventricular)
QRS morphology	Narrow if junctional escape; wide/bizarre if ventricular escape
PR interval	Variable — no fixed relationship

ECG Image

Complete third-degree AV heart block showing complete AV dissociation with slow ventricular escape rhythm

4. ⚡ Ventricular Tachycardia (VT)

What it is

A life-threatening arrhythmia originating below the Bundle of His (≥3 consecutive ventricular beats at ≥100 bpm). Often occurs in the setting of ischaemic heart disease, cardiomyopathy, or electrolyte disturbance.

ECG Changes

Feature	Finding
Rate	100–250 bpm, usually regular
QRS	Wide (>120 ms), bizarre morphology
P waves	AV dissociation — P waves march through independently
Fusion beats	Pathognomonic of VT
Capture beats	Narrow QRS amid wide complex — pathognomonic
Axis	Often extreme left or right axis deviation
Concordance	Positive concordance (all V leads upright) or negative concordance strongly suggests VT

ECG Image

Ventricular tachycardia ECG showing wide complex tachycardia with regular morphology

5. 🫁 Pulmonary Embolism (PE)

What it is

Obstruction of pulmonary vasculature causing acute right ventricular pressure overload. The ECG changes reflect acute right heart strain.

ECG Changes

Feature	Finding
Sinus tachycardia	Most common finding (>100 bpm)
S1Q3T3	Deep S in lead I, Q wave in lead III, T-wave inversion in lead III
RBBB	New incomplete or complete right bundle branch block
T-wave inversions	V1–V4 (right ventricular strain pattern)
Right axis deviation	Shift from baseline
P pulmonale	Tall peaked P waves in inferior leads (right atrial enlargement)
Sinus tachycardia	Most sensitive but least specific finding

ECG Image — Classic S1Q3T3 Pattern

Pulmonary embolism ECG showing S1Q3T3 pattern with sinus tachycardia and right heart strain

ECG Image — Acute RV Strain with T-wave Inversions

PE ECG with S1Q3T3 and precordial T-wave inversions indicating right ventricular strain

6. 🧬 Hypertrophic Cardiomyopathy (HCM)

What it is

Genetic disorder (autosomal dominant, sarcomere protein mutations) causing asymmetric myocardial hypertrophy, most commonly affecting the interventricular septum. Leading cause of sudden cardiac death in young athletes.

ECG Changes

Feature	Finding
LVH criteria	High voltage in precordial leads (Sokolow-Lyon: S-V1 + R-V5 >35 mm)
Strain pattern	ST depression + T-wave inversions in lateral leads (I, aVL, V4–V6)
Deep T inversions	Giant T-wave inversions in V3–V5 (apical HCM variant)
Abnormal Q waves	Deep narrow Q waves in lateral/inferior leads (septal hypertrophy)
Left axis deviation	Common
No septal Q waves	Absence of normal septal Q in V5–V6 (reversed septal depolarisation)

ECG Image — Septal HCM with LVH & Strain

Hypertrophic cardiomyopathy ECG showing LVH, strain pattern, and deep T-wave inversions

ECG Image — Apical HCM (Giant T-wave Inversions)

Apical hypertrophic cardiomyopathy ECG with giant T-wave inversions in V3-V5

7. ❄️ Acute Pericarditis

What it is

Inflammation of the pericardium, most commonly viral in origin. Presents with sharp pleuritic chest pain relieved by sitting forward.

ECG Changes

Feature	Finding
ST elevation	Diffuse, concave (saddle-shaped) in almost all leads except aVR and V1
PR depression	Classic early finding — depression in most leads, elevation in aVR
Spodick's sign	Downsloping TP segment (highly specific)
No reciprocal changes	Unlike STEMI — ST elevation is global, not regional
Temporal evolution	ST→ T-wave flattening → T inversion → normalisation (4 stages)
Electrical alternans	If large effusion with tamponade

ECG Image

Pericarditis ECG showing diffuse saddle-shaped ST elevation and PR depression in multiple leads

8. ⏱️ Long QT Syndrome (LQTS) & Torsades de Pointes

What it is

Disorder of cardiac repolarisation (congenital or acquired) that prolongs the QT interval and predisposes to a dangerous polymorphic VT called Torsades de Pointes ("twisting of the points"), which can degenerate into ventricular fibrillation.

ECG Changes

Feature	Finding
QTc prolongation	QTc >440 ms (men), >460 ms (women); danger threshold >500 ms
T-wave morphology	Notched, bifid, or prolonged T-waves; prominent U waves
Torsades de Pointes	Polymorphic VT with characteristic twisting QRS axis around the isoelectric line
Trigger	Often initiated by a PVC with short-long-short RR sequence
Self-terminating	Paroxysmal episodes of TdP, may degenerate to VF

ECG Image — Long QT + Torsades de Pointes

Long QT syndrome ECG from Harrison's showing prolonged QT interval and polymorphic ventricular tachycardia

ECG Image — Torsades de Pointes

Torsades de pointes ECG showing the classic twisting morphology of polymorphic ventricular tachycardia

9. 🔗 Wolff-Parkinson-White (WPW) Syndrome

What it is

Ventricular pre-excitation via an accessory pathway (Bundle of Kent) that bypasses the AV node, allowing premature ventricular depolarisation. Predisposes to re-entrant tachycardias and, in AF, to life-threatening rapid conduction.

ECG Changes

Feature	Finding
Short PR interval	<120 ms (bypasses normal AV node delay)
Delta wave	Slurred upstroke at the start of QRS — hallmark finding
Wide QRS	Broadened complex (>120 ms) due to pre-excitation
Secondary ST-T changes	Discordant ST/T changes (not ischemic)
Pseudo-infarction	Negative delta waves in inferior leads mimic Q-waves
AF with WPW	Extremely rapid irregular wide-complex rhythm (≥200 bpm) — medical emergency

ECG Image

Wolff-Parkinson-White syndrome ECG showing short PR interval, delta waves, and widened QRS complex

10. 🫀 Dilated Cardiomyopathy (DCM)

What it is

Dilated, poorly contracting left ventricle (EF <40%) due to ischaemic, genetic, viral, alcoholic, or idiopathic causes. The stretched, fibrotic myocardium produces characteristic ECG abnormalities.

ECG Changes

Feature	Finding
LBBB	Most common — broad monophasic R in I, aVL, V5–V6; QS in V1–V3
Left axis deviation	Common
Low voltage	QRS amplitude <5 mm in all limb leads (amyloid, pericardial effusion)
Fragmented QRS	Multiple notches within the QRS — marker of fibrosis
Atrial fibrillation	Very common complication of DCM
Non-specific ST-T changes	Widespread T-wave flattening or inversion
Q waves	May mimic infarction in ischaemic DCM

ECG Image — Dilated Cardiomyopathy with LBBB

Dilated cardiomyopathy ECG showing left bundle branch block and fragmented QRS in context of structural heart disease

Quick Reference Summary Table

#	Disease	Key ECG Hallmarks
1	STEMI	Convex ST elevation, reciprocal depression, Q waves
2	Atrial Fibrillation	No P waves, irregularly irregular, fibrillatory baseline
3	Complete AV Block	AV dissociation, slow escape rhythm, variable PR
4	Ventricular Tachycardia	Wide QRS >120 ms, AV dissociation, fusion/capture beats
5	Pulmonary Embolism	Sinus tach, S1Q3T3, RBBB, RV strain T inversions V1–V4
6	Hypertrophic Cardiomyopathy	LVH, strain, deep T inversions (apical), abnormal Q waves
7	Acute Pericarditis	Diffuse saddle ST elevation, PR depression, Spodick's sign
8	Long QT / TdP	QTc >500 ms, prominent U waves, twisting polymorphic VT
9	WPW Syndrome	Short PR <120 ms, delta wave, widened QRS
10	Dilated Cardiomyopathy	LBBB, low voltage, fragmented QRS, AF, non-specific ST-T changes

Clinical Pearl: Always interpret the ECG in clinical context. Many of these patterns can overlap (e.g., LBBB in DCM can mask STEMI; WPW can mimic VT in AF; pericarditis can mimic STEMI). Rate, rhythm, morphology, and clinical history together guide management.

Show normal ecg side by side with the defective ecg

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normal sinus rhythm 12 lead ECG healthy baseline

Reading File

Running Command

ls /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

Running Command

mkdir -p /home/daytona/workspace/ecg-comparison

Writing File

~/ecg-comparison/ecg_comparison.html

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<body>

<h1>❤️ ECG Comparison: Normal vs Pathological</h1>
<p class="subtitle">10 Common Heart Diseases — Side-by-Side Electrocardiogram Analysis</p>

<!-- NORMAL ECG REFERENCE BANNER -->
<div class="normal-banner">
  <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_8f341459857cb1f6810c616d1d5c43c3d15519522ba21d62db2b50f3dee4d54f.jpg" alt="Normal Sinus Rhythm ECG" />
  <div class="info">
    <h2>✅ Normal Sinus Rhythm — Reference ECG</h2>
    <ul>
      <li><strong>Rate:</strong> 60–100 bpm, regular</li>
      <li><strong>P waves:</strong> Present before every QRS, upright in II, inverted in aVR</li>
      <li><strong>PR interval:</strong> 120–200 ms (3–5 small squares)</li>
      <li><strong>QRS duration:</strong> &lt;120 ms (narrow), normal axis</li>
      <li><strong>R-wave progression:</strong> Normal V1→V6 transition</li>
      <li><strong>ST segments:</strong> Isoelectric — no elevation or depression</li>
      <li><strong>T waves:</strong> Upright in I, II, V3–V6; inverted in aVR</li>
      <li><strong>QTc:</strong> 350–440 ms</li>
      <li><strong>No pathological Q waves, no delta waves, no blocks</strong></li>
    </ul>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 1: STEMI -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#1a0000,#2d0000);">
    <div class="num">1</div>
    <h2>ST-Elevation Myocardial Infarction (STEMI)</h2>
    <span class="badge">EMERGENCY</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 STEMI — Anterior (LAD occlusion)</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_16738d4b125195130b5e53a811645d4064182fc2bbd0de16b0e00a57af7ff6ef.jpg" alt="Anterior STEMI ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>ST segments isoelectric in all leads</li>
          <li>No pathological Q waves</li>
          <li>Narrow QRS &lt;120 ms</li>
          <li>Normal T wave morphology</li>
          <li>Normal R-wave progression V1→V6</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>STEMI Changes</h4>
        <ul>
          <li><strong>Convex (tombstone) ST elevation</strong> V1–V6 ≥1 mm</li>
          <li><strong>Reciprocal ST depression</strong> in II, III, aVF</li>
          <li><strong>Hyperacute peaked T-waves</strong> early phase</li>
          <li><strong>Pathological Q waves</strong> develop within hours</li>
          <li>T-wave inversions follow ST elevation</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 2: ATRIAL FIBRILLATION -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#0d1a1a,#0d2626);">
    <div class="num">2</div>
    <h2>Atrial Fibrillation (AF)</h2>
    <span class="badge">ARRHYTHMIA</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 ATRIAL FIBRILLATION</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_55b3585ba004b0ca69f159c22eb5fbb4d8995fc007e77627c0d37922e4d88973.jpg" alt="Atrial Fibrillation ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Regular rhythm — equal R-R intervals</li>
          <li>Clear distinct P wave before each QRS</li>
          <li>Flat isoelectric baseline</li>
          <li>Consistent QRS morphology</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>AF Changes</h4>
        <ul>
          <li><strong>No P waves</strong> — replaced by fibrillatory (f) waves</li>
          <li><strong>Irregularly irregular</strong> R-R intervals</li>
          <li>Undulating chaotic baseline (350–600/min atrial)</li>
          <li>Narrow QRS (unless aberrant conduction)</li>
          <li>Variable ventricular rate 60–180 bpm</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 3: COMPLETE AV BLOCK -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#0d0d1a,#0d1533);">
    <div class="num">3</div>
    <h2>Complete (3rd Degree) AV Block</h2>
    <span class="badge">CONDUCTION</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 COMPLETE AV BLOCK (3rd Degree)</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_aeb984a3d643e0df6ca0ccdeab021262c2023d848ce082be901b58452da13940.jpg" alt="Complete Heart Block ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Fixed PR interval 120–200 ms</li>
          <li>Every P wave followed by QRS</li>
          <li>P rate = ventricular rate (60–100 bpm)</li>
          <li>Narrow QRS, normal escape</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>Complete AV Block Changes</h4>
        <ul>
          <li><strong>Complete AV dissociation</strong> — P waves and QRS independent</li>
          <li><strong>Ventricular rate 20–40 bpm</strong> (ventricular escape)</li>
          <li><strong>Wide, bizarre QRS</strong> (infranodal escape focus)</li>
          <li>No fixed PR interval — varies constantly</li>
          <li>Atrial rate regular, faster than ventricular</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 4: VENTRICULAR TACHYCARDIA -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#1a0a00,#2d1400);">
    <div class="num">4</div>
    <h2>Ventricular Tachycardia (VT)</h2>
    <span class="badge">EMERGENCY</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 VENTRICULAR TACHYCARDIA</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_d15a92de4e89b46f273b22d254d1e30fcd6a190c6d581b193e6dd338338c6bb6.jpg" alt="Ventricular Tachycardia ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Narrow QRS &lt;120 ms</li>
          <li>Rate 60–100 bpm</li>
          <li>P waves precede every QRS</li>
          <li>Normal QRS morphology</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>VT Changes</h4>
        <ul>
          <li><strong>Wide QRS &gt;120 ms</strong>, bizarre morphology</li>
          <li><strong>Rate 100–250 bpm</strong>, regular</li>
          <li><strong>AV dissociation</strong> — P waves independent</li>
          <li><strong>Fusion &amp; capture beats</strong> — pathognomonic</li>
          <li>Positive concordance across V1–V6 (all positive)</li>
          <li>Extreme axis deviation</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 5: PULMONARY EMBOLISM -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#001a0d,#002d16);">
    <div class="num">5</div>
    <h2>Pulmonary Embolism (PE)</h2>
    <span class="badge">EMERGENCY</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 PULMONARY EMBOLISM — S1Q3T3 Pattern</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_5f391caa5a24ec425e9f48d4d9f73620a3b91f98df1f92cea400318772fda12e.jpg" alt="Pulmonary Embolism ECG S1Q3T3" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Normal rate (60–100 bpm)</li>
          <li>No S wave in lead I</li>
          <li>No Q wave or T inversion in lead III</li>
          <li>Normal right precordial leads</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>PE Changes</h4>
        <ul>
          <li><strong>Sinus tachycardia</strong> — most common finding</li>
          <li><strong>S1Q3T3</strong> — deep S in I, Q wave + T inversion in III</li>
          <li><strong>New RBBB</strong> (incomplete or complete)</li>
          <li>T inversion V1–V4 (RV strain pattern)</li>
          <li>Right axis deviation, P pulmonale</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 6: HYPERTROPHIC CARDIOMYOPATHY -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#0d001a,#1a0033);">
    <div class="num">6</div>
    <h2>Hypertrophic Cardiomyopathy (HCM)</h2>
    <span class="badge">STRUCTURAL</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 HYPERTROPHIC CARDIOMYOPATHY — Apical variant</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_f9136e8a77fe104cfbe3b8d6deb3a988a0925e95c5f6acba5afb957453257c47.jpg" alt="HCM ECG with giant T-wave inversions" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Normal QRS voltage</li>
          <li>Upright T waves in lateral leads</li>
          <li>Septal Q waves present in V5–V6 (normal)</li>
          <li>No ST changes</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>HCM Changes</h4>
        <ul>
          <li><strong>LVH criteria</strong> — high voltage S-V1 + R-V5 &gt;35 mm</li>
          <li><strong>Giant T-wave inversions</strong> V3–V5 (apical HCM)</li>
          <li><strong>Strain pattern</strong> — ST depression + T inversions lateral leads</li>
          <li>Deep narrow Q waves in inferior/lateral leads</li>
          <li>Absent septal Q waves in V5–V6</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 7: ACUTE PERICARDITIS -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#001a1a,#002b2b);">
    <div class="num">7</div>
    <h2>Acute Pericarditis</h2>
    <span class="badge">INFLAMMATORY</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 ACUTE PERICARDITIS</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_cd4008531c1b1a2a99ab6d9b4282dcdcedfcf77c302b6ecbb7f7e01c5c985cf9.jpg" alt="Acute Pericarditis ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Flat isoelectric PR segments</li>
          <li>Isoelectric ST segments</li>
          <li>Upright T waves in lateral leads</li>
          <li>No diffuse changes</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>Pericarditis Changes</h4>
        <ul>
          <li><strong>Diffuse saddle-shaped ST elevation</strong> (all leads except aVR, V1)</li>
          <li><strong>PR segment depression</strong> — classic early sign</li>
          <li><strong>PR elevation in aVR</strong> (reciprocal)</li>
          <li><strong>Spodick's sign</strong> — downsloping TP segment</li>
          <li>No reciprocal depression (unlike STEMI)</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 8: LONG QT / TORSADES -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#1a1a00,#2b2b00);">
    <div class="num">8</div>
    <h2>Long QT Syndrome &amp; Torsades de Pointes</h2>
    <span class="badge">CHANNELOPATHY</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG — QTc 350–440 ms</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 LONG QT → TORSADES DE POINTES (Harrison's)</div>
        <img src="https://cdn.orris.care/cdss_images/HARRISON_1763034143291_d1a2f9c1-7f66-4dec-a3f8-19b81f2ba927.png" alt="Long QT and Torsades de Pointes ECG from Harrison's" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>QTc 350–440 ms (male), &lt;460 ms (female)</li>
          <li>Normal T wave morphology — not notched</li>
          <li>No prominent U waves</li>
          <li>Regular sinus rhythm</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>Long QT / TdP Changes</h4>
        <ul>
          <li><strong>QTc &gt;500 ms</strong> — danger threshold</li>
          <li><strong>Notched/bifid T waves</strong>, prominent U waves</li>
          <li><strong>Torsades de Pointes</strong> — twisting polymorphic VT</li>
          <li>PVC with short-long-short trigger initiates TdP</li>
          <li>Self-terminating but may degenerate to VF</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 9: WPW SYNDROME -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#001a0a,#003319);">
    <div class="num">9</div>
    <h2>Wolff-Parkinson-White (WPW) Syndrome</h2>
    <span class="badge">PRE-EXCITATION</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG — Normal PR interval, no delta wave</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_32202ebda4ec9404cf20f0a12d7fac22611ed6349c65e22fcd92d964de676b10.jpg" alt="Normal ECG baseline for WPW" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 WPW SYNDROME — Delta Wave, Short PR</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_fd0d58cc1913acd56cbc62cbf42657e4a465f052a9bb2ea0d3893584ef6f70e6.jpg" alt="WPW ECG with delta waves" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>PR interval 120–200 ms</li>
          <li>Sharp, narrow QRS onset (no delta)</li>
          <li>QRS &lt;120 ms</li>
          <li>Normal T wave concordance</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>WPW Changes</h4>
        <ul>
          <li><strong>Short PR &lt;120 ms</strong> — bypasses AV node</li>
          <li><strong>Delta wave</strong> — slurred upstroke at QRS onset</li>
          <li><strong>Widened QRS &gt;120 ms</strong></li>
          <li>Discordant secondary ST-T changes</li>
          <li>Pseudo-infarction Q waves (negative delta in inferior leads)</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<!-- =========================================================== -->
<!-- DISEASE 10: DILATED CARDIOMYOPATHY -->
<!-- =========================================================== -->
<div class="disease-card">
  <div class="card-header" style="background: linear-gradient(90deg,#1a0a0d,#2d1218);">
    <div class="num">10</div>
    <h2>Dilated Cardiomyopathy (DCM)</h2>
    <span class="badge">STRUCTURAL</span>
  </div>
  <div class="card-body">
    <div class="ecg-row">
      <div class="ecg-panel normal-panel">
        <div class="panel-label">✅ NORMAL ECG</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_7378a9205a98329a42c340ff3f26f55fba6da3f3e1f21a1231c367266e174c4a.jpg" alt="Normal ECG" />
      </div>
      <div class="ecg-panel abnormal-panel">
        <div class="panel-label">🔴 DILATED CARDIOMYOPATHY — LBBB pattern</div>
        <img src="https://cdn.orris.care/cdss_images/pmc_clinical_VQA_3458bf02be74ff6aa57a9c6a0409235cb092d3a4cf29ef11c03f844a2f6ac26b.jpg" alt="Dilated Cardiomyopathy ECG" />
      </div>
    </div>
    <div class="changes-grid">
      <div class="change-col normal-col">
        <h4>Normal Findings</h4>
        <ul>
          <li>Normal QRS voltage</li>
          <li>Narrow QRS &lt;120 ms</li>
          <li>Normal R-wave progression</li>
          <li>Regular sinus rhythm</li>
        </ul>
      </div>
      <div class="change-col abnormal-col">
        <h4>DCM Changes</h4>
        <ul>
          <li><strong>LBBB</strong> — broad R in I, aVL, V5–V6; QS in V1–V3</li>
          <li><strong>Low voltage</strong> — QRS &lt;5 mm all limb leads</li>
          <li><strong>Fragmented QRS</strong> — notching, marker of fibrosis</li>
          <li>Atrial fibrillation (common complication)</li>
          <li>Non-specific ST-T changes, left axis deviation</li>
        </ul>
      </div>
    </div>
  </div>
</div>

<footer>
  <p>ECG images sourced from peer-reviewed medical literature and Harrison's Principles of Internal Medicine (21st Ed.)</p>
  <p style="margin-top:6px;">For educational purposes only. Always interpret ECGs in full clinical context.</p>
</footer>

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