ECG (peds): Difference between revisions
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==Axis== | ==Axis== | ||
[[File:QRS axis.png|thumb|]] | |||
*Right axis ''normal'' in first 6 months of life | *Right axis ''normal'' in first 6 months of life | ||
**Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis | **Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis | ||
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**Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle | **Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle | ||
**Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010] | **Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010] | ||
==Intervals== | ==Intervals== | ||
[[File:Intervals.png|thumb|]] | |||
*Age dependant norms | *Age dependant norms | ||
*Smaller muscle mass--> shorter PR | *Smaller muscle mass--> shorter PR | ||
*QTc longer in infants <6mo | *QTc longer in infants <6mo | ||
==T-wave inversions== | ==T-wave inversions== | ||
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*T-waves typically inverted from 7 days to adolescence | *T-waves typically inverted from 7 days to adolescence | ||
*Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic) | *Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic) | ||
==Voltage/Ventricular hypertrophy== | ==Voltage/Ventricular hypertrophy== | ||
[[File:Voltage RVH-LVH.png|thumb|]] | |||
*Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages | *Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages | ||
**V2-V5 most likely to appear high voltage | **V2-V5 most likely to appear high voltage | ||
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**If RSR' present; R' taller than R wave | **If RSR' present; R' taller than R wave | ||
**Pure R wave in V1 in child >6mo | **Pure R wave in V1 in child >6mo | ||
==See Also== | ==See Also== | ||
*[[ | *[[ECG (main)]] | ||
*[[Congenital heart disease]] | *[[Congenital heart disease]] | ||
*[[PALS (Main)]] | *[[PALS (Main)]] | ||
Latest revision as of 23:46, 28 November 2019
This page is for pediatric patients. For adult patients, see: ECG (main)
Ventricular rate
- Younger/smaller --> higher metabolic rate + lower vagal tone --> faster HR
Axis
- Right axis normal in first 6 months of life
- Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis
- Extreme superior axis
- Axis of -90 - 180 degrees
- Seen with AV canal or atrial septal defects
- AVF lead vector
- Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle
- Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010]
Intervals
- Age dependant norms
- Smaller muscle mass--> shorter PR
- QTc longer in infants <6mo
T-wave inversions
- T-wave inversions in anterior precordial leads are normal
- T-waves upright in most leads for first 7 days of life
- T-waves typically inverted from 7 days to adolescence
- Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic)
Voltage/Ventricular hypertrophy
- Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages
- V2-V5 most likely to appear high voltage
- EKG auto-interpretations may "over-report" left or right ventricular hypertrophy
- LVH (quick/dirty method)
- If R of V6 intersects with baseline of V5--> abnormal
- RVH indicators
- Upright T-wave in V1 after 7 days of life
- If RSR' present; R' taller than R wave
- Pure R wave in V1 in child >6mo
See Also
External Links
- https://pedemmorsels.com/pediatric-ecg/
- https://litfl.com/paediatric-ecg-interpretation-ecg-library/