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Differential diagnosis of basic electrocardiographic abnormalities

Differential diagnosis of basic electrocardiographic abnormalities
Author:
Ary L Goldberger, MD
Section Editor:
David M Mirvis, MD
Deputy Editor:
Susan B Yeon, MD, JD, FACC
Literature review current through: Nov 2022. | This topic last updated: Dec 07, 2022.

INTRODUCTION — The electrocardiographic diagnosis of a variety of cardiac diseases, such as ischemia or infarction, pericarditis, and conduction disturbances, is based upon certain characteristic findings. However, none of these findings alone is usually pathognomonic for a particular disease.

This topic presents a series of tables that list the major causes of a number of common findings and abnormalities [1-4]. Their differential diagnosis is discussed in detail in the appropriate topic reviews.

Q waves (table 1).

ST-segment elevations (table 2).

Low QRS voltage (table 3).

Prominent T-wave inversions (table 4).

Tall, positive (peaked) T waves (table 5).

Wide QRS complex (table 6). (See "Wide QRS complex tachycardias: Approach to the diagnosis".)

Right axis deviation (table 7).

Long QT interval (table 8). (See "Acquired long QT syndrome: Definitions, pathophysiology, and causes" and "Acquired long QT syndrome: Clinical manifestations, diagnosis, and management" and "Congenital long QT syndrome: Diagnosis".)

Tall R wave in V1/V2 (table 9).

  1. Goldberger AL, Goldberger ZD, Shvilkin A. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed, Elsevier/Saunders, Philadelphia 2018.
  2. Goldberger AL. Myocardial infarction: Electrocardiographic differential diagnosis, 4th ed, Mosby Year Book, St Louis 1991.
  3. Surawicz, B, Knilans, TK. Chou's Electrocardiography in Clinical Practice, 6th ed, W.B. Saunders Company, Philadelphia 2008.
  4. Mirvis DM, Goldberger AL. Electrocardiography. In: Braunwald’s Heart Disease, 12th ed, Libby P, Bonow RO, Mann DL, et al. (Eds), Elsevier, 2022. p.141.
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