Download - Ecg pediatric
![Page 1: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/1.jpg)
Pediatric ECG:A practical Approach
Dr ANIL S.R
Consultant Pediatric Cardiologist MIMS Calicut
![Page 2: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/2.jpg)
• A wriggling neonate• A crying infant• An apprehensive child• A ticklish adolescent
ECG in pediatric Practice
![Page 3: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/3.jpg)
![Page 4: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/4.jpg)
• Evolution of ECG- Neonate to Adolescent• Identify an abnormal ECG at a given age• ECG and Common congenital heart diseases• ECG abnormalities after surgical interventions• Pediatric arrhythmias
ECG in pediatric Practice
![Page 5: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/5.jpg)
Normal neonate
![Page 6: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/6.jpg)
Normal infant
Low voltages of QRS in precordial and limb leads
Low T wave voltages
RV dominance
Right Axis deviation of upto 180 degree
Upright T waves in right precordial leads- Ist week of life
![Page 7: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/7.jpg)
Normal Child
![Page 8: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/8.jpg)
Normal adolescent
![Page 9: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/9.jpg)
Age related changes
• HR decreases• All durations and intervals increases• RV dominance gradually changes to LV
dominance• QRS axis- less rightward shift• R wave in RPLs decreases and in LPLs
it increases. This is reverse for S wave
![Page 10: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/10.jpg)
LV/RV Mass ratio
30w 1.2:1
33w 1:1
Birth 0.8:1
6m 2:1
Adult 2.5:1
![Page 11: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/11.jpg)
Preterm infants
Low voltages of QRS
Low T wave voltages
Less RV dominance
Left Axis deviation
Short PR, QRS and QT intervals
More ECG variability
![Page 12: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/12.jpg)
![Page 13: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/13.jpg)
Leads
Bipolar leads : I , II, IIIUnipolar leads : aVR, aVL, aVF V1 to V6
![Page 14: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/14.jpg)
LEADS: Bipolar leads : I , II, III
Lead I
Lead II Lead III
LARA
LL
• Selected by Einthoven• Records PD between two
points• Rt leg electrode- ground
wire• II = 1 + 111 (Kirchoff’s Law)
![Page 15: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/15.jpg)
Laws of ECG
• Depolarization is towards the +ve of a lead= +Ve Deflection
• Depolarization is towards the -ve of a lead= -Ve Deflection
• Depolarization is perpendicular to the lead= Biphasic or No Deflection
![Page 16: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/16.jpg)
![Page 17: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/17.jpg)
![Page 18: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/18.jpg)
![Page 19: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/19.jpg)
Right atrial Enlargement
![Page 20: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/20.jpg)
Left atrial Enlargement
![Page 21: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/21.jpg)
Right Ventricular Hypertrophy
![Page 22: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/22.jpg)
Left Ventricular Hypertrophy
![Page 23: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/23.jpg)
![Page 24: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/24.jpg)
Common congenital heart defects
Left to right shuntsStenotic lesions
Cyanotic heart diseases
![Page 25: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/25.jpg)
Secundum ASD
![Page 26: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/26.jpg)
![Page 27: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/27.jpg)
Primum ASD.... Left axis deviation and Q in aVL
![Page 28: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/28.jpg)
Sinus venosus ASD ... Note inverted P waves in III
![Page 29: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/29.jpg)
![Page 30: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/30.jpg)
Small VSD in a young child ..... No LV forces
![Page 31: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/31.jpg)
![Page 32: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/32.jpg)
Large VSD with biventricular forces ....... Note Katz Wachtel phenomenon
![Page 33: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/33.jpg)
VSD Eisenmenger......note loss of q wave in V6
![Page 34: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/34.jpg)
Large Inlet VSD, ......note left axis
![Page 35: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/35.jpg)
PDA ... Note prominent LV forces
![Page 36: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/36.jpg)
PDA in Rubella syndrome patients
Left axis deviation due to injury to conduction tissues
![Page 37: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/37.jpg)
![Page 38: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/38.jpg)
AS with LVH, note strain pattern
![Page 39: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/39.jpg)
AS with significant LVH and strain pattern
![Page 40: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/40.jpg)
Coarctation in infancy ..... Since PAH is common, RV forces are dominant
![Page 41: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/41.jpg)
Coarctation
• In infancy, due to pulmonary hypertension, Right axis and RVH are common
• In older patients, LVH occurs
![Page 42: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/42.jpg)
Coarctation in an older child
![Page 43: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/43.jpg)
![Page 44: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/44.jpg)
Valvar PS
![Page 45: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/45.jpg)
![Page 46: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/46.jpg)
Sick TOF
![Page 47: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/47.jpg)
TOF - Transition occurs in V1Importance of right chest leads
![Page 48: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/48.jpg)
![Page 49: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/49.jpg)
D-TGA in a older child
![Page 50: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/50.jpg)
![Page 51: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/51.jpg)
Corrected TGA with large VSD.......Note septal Q in right sided leads, no Q in V6
![Page 52: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/52.jpg)
Common atrium.....mimics a primum ASD, but patient is blue
![Page 53: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/53.jpg)
Ebstein’s anomaly of tricuspid valve....... Striking RA forces, splintered qrs in V1
![Page 54: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/54.jpg)
TAPVC
![Page 55: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/55.jpg)
TAPVC ... ECG shows features of PAH
![Page 56: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/56.jpg)
![Page 57: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/57.jpg)
Tricuspid atresia..... Left axis and LV forces
![Page 58: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/58.jpg)
Pulmonary atresia, Intact IVS..... Again LV forces but axis is not leftward
![Page 59: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/59.jpg)
![Page 60: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/60.jpg)
Single ventricle - RAD with LV forces
![Page 61: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/61.jpg)
In a cyanotic child:• Right ventricular forces: TOF
TOF with pulmonary atresiaTGATAPVC, Common atrium
• Left ventricular forces:Tricuspid atresiaPulmonary atresia with
IVSHypoplastic right heartSingle ventricleEbsteins
• Bi-ventricular forces: TruncusDORV
• Normal ECG: Pulmonary AV fistula Anomalous systemic venous return
![Page 62: Ecg pediatric](https://reader033.vdocuments.mx/reader033/viewer/2022061212/5495bceab47959384d8b4d90/html5/thumbnails/62.jpg)
Provides valuable clues in diagnosis
Invaluable in arrhythmia
Comprehensive assessment before surgery
Read and analyze ECGs
Conclusion