Give 10 heart disease with possible chages in ECG
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10 heart diseases ECG changes classic findings
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10 Heart Diseases and Their ECG Changes
Based on Braunwald's Heart Disease, Harrison's Principles of Internal Medicine (2025), Tintinalli's Emergency Medicine, and Ganong's Review of Medical Physiology:
1. ST-Elevation Myocardial Infarction (STEMI)
| Phase | ECG Finding |
|---|---|
| Hyperacute (minutes) | Tall, peaked (hyperacute) T waves |
| Acute (hours) | ST-segment elevation ≥1 mm in 2+ contiguous leads; reciprocal ST depression in opposing leads |
| Evolving (hours-days) | T-wave inversion |
| Old MI | Pathological Q waves (>1 mm wide, >25% of R-wave height) |
- Inferior MI (RCA): ST elevation in II, III, aVF
- Anterior MI (LAD): ST elevation in V1-V4
- Lateral MI (LCx): ST elevation in I, aVL, V5-V6
2. Non-ST-Elevation MI (NSTEMI) / Unstable Angina
- ST depression (horizontal or downsloping) in affected leads
- T-wave inversion (deep, symmetrical)
- No pathological Q waves
- Biomarker elevation distinguishes NSTEMI from unstable angina (ECG alone cannot)
3. Left Ventricular Hypertrophy (LVH)
- Sokolow-Lyon criteria: S in V1 + R in V5 or V6 > 35 mm
- Cornell criteria: R in aVL + S in V3 > 28 mm (men) / >20 mm (women)
- Left axis deviation
- ST depression and T-wave inversion in lateral leads (V5-V6, I, aVL) - the "strain pattern"
- Broad, notched P waves (P mitrale) if left atrial enlargement coexists
4. Right Ventricular Hypertrophy (RVH)
- Right axis deviation (>+110°)
- Tall R wave in V1 (R > S in V1)
- Deep S waves in V5-V6
- T-wave inversion in V1-V3 (right ventricular strain)
- P pulmonale: tall, peaked P waves >2.5 mm in lead II
5. Atrial Fibrillation (AF)
- Absent P waves replaced by irregular fibrillatory baseline (f waves, 350-600/min)
- Irregularly irregular R-R intervals
- No distinct P waves before QRS complexes
- Normal QRS morphology (unless aberrant conduction)
6. Wolff-Parkinson-White Syndrome (WPW)
- Short PR interval (<120 ms)
- Delta wave (slurred upstroke of QRS)
- Wide QRS complex (>120 ms)
- Secondary ST-T changes (discordant to delta wave)
- Risk: can rapidly conduct AF to ventricles (dangerous)
7. Complete Heart Block (3rd Degree AV Block)
- P waves and QRS complexes completely dissociated (no relationship between P and QRS)
- Atrial rate is normal (60-100 bpm); ventricular rate is slow (20-60 bpm)
- Escape rhythm: junctional (narrow QRS, 40-60 bpm) or ventricular (wide QRS, 20-40 bpm)
- Regular P-P intervals and regular R-R intervals - but independent of each other
8. Hypertrophic Cardiomyopathy (HCM)
- LVH voltage criteria (most common finding)
- Deep, narrow Q waves in lateral leads (I, aVL, V5-V6) and inferior leads - "dagger Q waves"
- Giant negative T waves in precordial leads (especially apical variant - Yamaguchi syndrome)
- Left axis deviation
- Shortened PR interval (in some)
- AF is common in advanced disease
9. Pericarditis (Acute)
ECG evolves in 4 classic stages:
| Stage | Timing | Finding |
|---|---|---|
| I | Day 1-2 | Diffuse saddle-shaped ST elevation in most leads (except aVR, V1); PR depression |
| II | Days 3-7 | ST normalizes; T waves flatten |
| III | 1-3 weeks | T-wave inversion (diffuse) |
| IV | Weeks-months | ECG normalizes |
Key differentiator from MI: PR depression is highly specific; ST elevation is diffuse (not territorial), concave (saddle-shaped).
10. Dilated Cardiomyopathy (DCM)
- Left bundle branch block (LBBB) is very common
- Poor R-wave progression in precordial leads (V1-V4)
- Pathological Q waves (mimicking old MI - "pseudo-infarct" pattern)
- Left axis deviation
- Non-specific ST-T wave changes
- P mitrale (left atrial enlargement)
- Frequent ventricular ectopy and ventricular tachycardia on monitoring
Analysis of the Attached ECG
Looking at the ECG strip you've shared (patient appears to be female, "F", from the header):
Visible findings:
- The machine interpretation at the bottom right appears to read: "Left Ventricular Involvement" and references ST changes
- The printed computer interpretation notes mention QTCD and Left Ventricular Abnormality
- Rhythm appears to be sinus rhythm (regular P waves visible)
- There appear to be prominent S waves in right precordial leads (V1-V2) and tall R waves in lateral leads (V5-V6) consistent with LVH
- The ST-T segment changes visible in lateral leads may represent LV strain pattern
Note: This is a preliminary visual impression only. The resolution and orientation of the ECG makes definitive interpretation difficult. A qualified physician should review the original tracing with full clinical context. The machine-generated interpretation at the bottom of the strip should be confirmed by a clinician.
Summary Table:
| # | Disease | Key ECG Feature |
|---|---|---|
| 1 | STEMI | ST elevation + Q waves |
| 2 | NSTEMI/UA | ST depression + T-wave inversion |
| 3 | LVH | High voltage + strain pattern |
| 4 | RVH | R>S in V1 + right axis deviation |
| 5 | Atrial Fibrillation | No P waves + irregular rhythm |
| 6 | WPW | Delta wave + short PR |
| 7 | Complete Heart Block | P-QRS dissociation |
| 8 | HCM | Dagger Q waves + giant T inversions |
| 9 | Pericarditis | Diffuse saddle ST + PR depression |
| 10 | DCM | LBBB + pseudo-infarct Q waves |
Sources: Braunwald's Heart Disease; Harrison's Principles of Internal Medicine 22E (2025); Tintinalli's Emergency Medicine; Ganong's Review of Medical Physiology
Create a quick-reference PDF guide to ECG patterns in heart disease
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PDF generated successfully (46 KB). Here is your download link:
ECG Quick Reference Guide
PDF Document · PDF
Here's what's included in the guide:
Structure (13 pages, A4):
| Section | Content |
|---|---|
| Cover page | Title, category overview boxes (Ischaemic / Arrhythmia / Conduction / Structural / Inflammatory), schematic ECG trace |
| Table of Contents | All 10 conditions with category and urgency level; ECG waveform basics reference table (P wave, PR, QRS, ST, T, QT normals) |
| 10 Condition Pages | One full page per condition |
| Summary Table | All 10 conditions side-by-side at a glance |
Each condition page contains:
- Colour-coded header bar with condition name, category, and urgency rating
- Programmatically drawn schematic ECG trace on an authentic pink grid background (unique morphology per condition)
- Key ECG Findings table - 5 specific findings with explanations
- Lead Territories / Patterns table - which leads show what
- Clinical Pearl - the most important "don't miss" fact
Conditions covered: STEMI, NSTEMI/UA, LVH, RVH, Atrial Fibrillation, WPW, Complete Heart Block (3rd degree), HCM, Acute Pericarditis, Dilated Cardiomyopathy
Sources cited: Braunwald's Heart Disease, Harrison's Principles 22E (2025), Tintinalli's Emergency Medicine, Ganong's Physiology, Roberts & Hedges' Clinical Procedures
Search for ECG practice cases to test your knowledge
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ECG quiz cases free practice
Here's a curated, well-organised guide to the best free ECG practice resources available right now:
Best Free ECG Practice Case Resources
1. LITFL - Life in the Fast Lane ECG Quiz Library
This is arguably the single best free ECG case library on the internet. Over 150 real 12-lead ECG cases, each with a clinical scenario, a full systematic analysis, and a detailed explanation. Cases cover everything from common to rare and genuinely challenging diagnoses.
Sample cases available:
- STEMI, NSTEMI, posterior MI, Wellens syndrome
- Brugada syndrome, WPW, Long QT
- Pericarditis, PE (S1Q3T3), hypothermia (J waves)
- Takotsubo cardiomyopathy, ARVC
- Digoxin toxicity, hyperkalemia, hypokalemia
- Pacemaker malfunction, lead reversal
- Left main coronary artery occlusion (aVR elevation)
Best for: All levels. Emergency medicine and critical care focus. Completely free.
2. Dr. Smith's ECG Blog
The gold standard for subtle ischaemia and occlusion-MI patterns. Dr. Stephen Smith (EM physician, Hennepin Healthcare) posts real cases with expert analysis, often featuring patterns that machines and junior doctors miss - De Winter T waves, subtle posterior STEMI, Wellens syndrome, LBBB with Sgarbossa criteria.
Best for: Intermediate to advanced learners. EM residents, registrars, anyone wanting to go beyond textbook ECGs.
3. Oxford Medical Education - ECG Quiz
15+ structured cases with real ECG images, clinical vignettes, and systematic structured answers (Rate / Rhythm / Axis / PR / QRS / ST-T / QTc). Each case has a show/hide answer format. Good for learning a structured approach.
Sample cases include: AF (holiday heart), STEMI, Brugada, WPW, posterior infarct, left main stem occlusion.
Best for: Medical students and junior doctors learning systematic ECG reading.
4. ECG Weekly - Workout Quiz / Competition Cases
A 2025 ECG competition series with real patient cases, point-scored answers, and full explanations. Cases covered in the free portion include:
- Mobitz I (Wenckebach) AV block
- AF with RBBB and inferior MI
- Complete heart block with junctional escape
- Short QT (hypercalcaemia)
- Sinus rhythm with dextrocardia
- Hypothermia with J waves (Osborn waves)
Best for: Competitive self-testing, senior students, residents. Some advanced content requires a subscription.
5. Practical Clinical Skills - EKG Practice Drills
Over 600 EKG tracings in a multiple-choice quiz format with immediate feedback. Organised by category (rhythms, blocks, ischaemia, paced rhythms). Has specific quizzes for nurses, ACLS prep, NCLEX, and NP/PA students. Free tier available; certificates for registered users.
Best for: Rhythm recognition drills, nursing staff, ACLS preparation.
6. SkillStat - Six Second ECG & 12-Lead Practice
Structured 15-question quizzes by category:
- Exercise 1: Basic rhythms
- Exercise 2A: Atrial and junctional rhythms
- Exercise 3A: Ventricular and paced rhythms
- ECG 360 Simulator (full-spectrum tool)
Best for: Paramedics, nurses, ACLS students. Clean interface, good for timed practice.
7. Rosh Review - ECG Qbank
Real ECG cases with one-liner clinical context, created by Pendell Meyers MD from Dr. Smith's ECG Blog content. High-yield format for exam preparation. Free trial available; paid for full access.
Best for: EM boards preparation, systematic high-yield study.
Recommended Study Approach
| Stage | Resource | Focus |
|---|---|---|
| Beginner | Oxford Medical Education | Structured systematic reading |
| Intermediate | LITFL Top 150 ECG Library | Broad case variety, real tracings |
| Advanced | Dr. Smith's ECG Blog | Subtle ischaemia, occlusion-MI patterns |
| Rapid drilling | Practical Clinical Skills / SkillStat | Rhythm recognition under time pressure |
| Competitive | ECG Weekly Workout | High-difficulty mixed cases with scoring |
Pro tip: The LITFL ECG library also has a companion ECG Library Basics section with over 100 topic summaries (Brugada, Sgarbossa criteria, Ashman phenomenon, etc.) that pair perfectly with the quiz cases.
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