ecg pediatric
DESCRIPTION
TRANSCRIPT
Pediatric ECG:A practical Approach
Dr ANIL S.R
Consultant Pediatric Cardiologist MIMS Calicut
• A wriggling neonate• A crying infant• An apprehensive child• A ticklish adolescent
ECG in pediatric Practice
• 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
Normal neonate
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
Normal Child
Normal adolescent
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
LV/RV Mass ratio
30w 1.2:1
33w 1:1
Birth 0.8:1
6m 2:1
Adult 2.5:1
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
Leads
Bipolar leads : I , II, IIIUnipolar leads : aVR, aVL, aVF V1 to V6
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)
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
Right atrial Enlargement
Left atrial Enlargement
Right Ventricular Hypertrophy
Left Ventricular Hypertrophy
Common congenital heart defects
Left to right shuntsStenotic lesions
Cyanotic heart diseases
Secundum ASD
Primum ASD.... Left axis deviation and Q in aVL
Sinus venosus ASD ... Note inverted P waves in III
Small VSD in a young child ..... No LV forces
Large VSD with biventricular forces ....... Note Katz Wachtel phenomenon
VSD Eisenmenger......note loss of q wave in V6
Large Inlet VSD, ......note left axis
PDA ... Note prominent LV forces
PDA in Rubella syndrome patients
Left axis deviation due to injury to conduction tissues
AS with LVH, note strain pattern
AS with significant LVH and strain pattern
Coarctation in infancy ..... Since PAH is common, RV forces are dominant
Coarctation
• In infancy, due to pulmonary hypertension, Right axis and RVH are common
• In older patients, LVH occurs
Coarctation in an older child
Valvar PS
Sick TOF
TOF - Transition occurs in V1Importance of right chest leads
D-TGA in a older child
Corrected TGA with large VSD.......Note septal Q in right sided leads, no Q in V6
Common atrium.....mimics a primum ASD, but patient is blue
Ebstein’s anomaly of tricuspid valve....... Striking RA forces, splintered qrs in V1
TAPVC
TAPVC ... ECG shows features of PAH
Tricuspid atresia..... Left axis and LV forces
Pulmonary atresia, Intact IVS..... Again LV forces but axis is not leftward
Single ventricle - RAD with LV forces
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
Provides valuable clues in diagnosis
Invaluable in arrhythmia
Comprehensive assessment before surgery
Read and analyze ECGs
Conclusion