The Pediatric ECG
DR. ATUL KULKARNI
MD
DR MANDAR HAVAL
DCH DNB
Objectives
Review the cardiac physiology with respect to age, and age
related normals
Discuss wave morphology and axis as ...
Background
ECG changes during the first year of life reflect the switch
from fetal to infant circulation, changes in SVR, ...
Heart rate
 Average heart rate peaks at second month of life, then
gradually decreases
 Resting HRs start at 140 bpm at ...
• INTRINSIC HEART RATES
Newborn to 3 years:
• SA node 95 – 120
• AV node (junctional) 45 – 85
• Purkinje (ventricular) 35 ...
Age Related Normal Findings
Tables exists that include age
based normal ranges for heart
rate, QRS axis, PR and QRS
interv...
The P Wave
Best seen in leads II and V1
P wave amplitude does not change significantly
during childhood
Amplitudes of 0.02...
The QRS Complex
QRS complex duration is shorter,
presumable because of decreased muscle
mass
QRS complexes > 0.08 sec in p...
The T Wave
The T waves are frequently upright throughout the
precordium in the first week of life
Thereafter, T waves in V...
3 day old & 7 y/o
QRS Axis and Ventricular Dominance
At birth, the axis is markedly rightward
(+60 - +160), the R/S ratio is high in V1 and
...
What is the axis?
What is the axis?
LAD
Normal
RA
D
Lead I
AVF
Negative
+
+
_
Lead I AVF
Normal Positive Positive
RAD Negative Positive
LAD ...
What is the axis?
RIGHT
AXIS
DEVEATION
What is the axis?
LAD
What is the axis?
NORMAL
CHAMBER
HYPERTROPHY
Interpretation?
Right atrial enlargement
DIGNOSIS?
Left atrial
enlargement
Atrial Enlargement
RAE is diagnosed in the
presence of a peaked tall P
wave in II
In the first 6 months, the P
wave must b...
Interpretation?
Right ventricular hypertrophy (RVH)
RVH
Large R wave in V1 and
large S wave in V6
Upright T wave in V1-V3
RAD
Persistent pattern of RV
dominance
Right Ventric...
RVH
Interpretation?
Left ventricular hypertrophy (LVH)
LVH
R wave > 98th percentile
in V6 and S wave > 98th
percentile in V1
LV “strain” pattern in V5
and V6 or deep Q waves
in ...
CONDUCTION
ABNORMALITIES
Bundle branch blocks are diagnosed as they would
be in adults; RBBB occurs most commonly after
re...
Sinus Bradycardia
Deviation from NSR
- Rate < 60 bpm
 Etiology: SA node is depolarizing slower than
normal, impulse is co...
Sinus Tachycardia
Deviation from NSR
- Rate > 100 bpm
Etiology: SA node is depolarizing faster
than normal, impulse is con...
Interpretation?
Sinus Tachycardia
1st Degree AV Block
Etiology: Prolonged conduction delay in the
AV node or Bundle of His.
Diagnosis?
p
1st Degree AV Block
FIRST DEGREE HEART
BLOCK
PR interval > 5 small divisions, 0.2 secs
Causes: myocarditis, acute rheumatic fever,
drugs,
50 bpm• Rate?
• Regularity? regularly irregular
nl, but 4th no QRS
0.08 s
• P waves?
• PR interval? lengthens
• QRS durati...
2nd Degree AV Block, Type I
Deviation from NSR
 PR interval progressively lengthens, then
the impulse is completely block...
40 bpm• Rate?
• Regularity? regular
nl, 2 of 3 no QRS
0.08 s
• P waves?
• PR interval? 0.14 s
• QRS duration?
Interpretati...
2nd Degree AV Block, Type II
Deviation from NSR
 Occasional P waves are completely blocked
(P wave not followed by QRS).
...
Rhythm #13
40 bpm• Rate?
• Regularity? regular
no relation to QRS
wide (> 0.12 s)
• P waves?
• PR interval? none
• QRS dur...
Diagnosis?
3rd Degree AV Block
Diagnosis?
RBBB
RIGHT BUNDLE BRANCH
BLOCK
Wide QRS > 0.12 s ( 3 small divisions)
M morphology in V1
V1
“Rabbit Ears”
Diagnosis?
LBBB
LEFT BUNDLE BRANCH
BLOCK
Wide QRS > 0.12 s ( > 3 small divisions)
M morphology in V 6 and W in V1
ARRHYTHMIAS
13 y/o with palpitations
Paroxysmal supraventricular
tachycardia (PSVT)
22 day old with poor feeding
Paroxysmal supraventricular
tachycardia (PSVT)
Diagnosis?
Paroxysmal supraventricular
tachycardia (PSVT)
Paroxysmal supraventricular tachycardia
(PSVT)
Regularity: Regular
Rate : >180/min
P wave morphology: Different from sinus...
Diagnosis
What is the rate?
Is the QRS wide or
narrow?
Causes
Ventricular tachycardia
Ventricular tachycardia
Rate > 120 / min
QRS > 0.08 secs
Causes: myocarditis,
LCAPA, tumour, Long
QT, drugs, surgery
Diagnosis?
Torsades de pointis
Torsades de pointis
Torsades de pointis
Gradual change in
amplitude of QRS
Rate 150-250/min
Prolonged QT
interval, Hypokalemia,
hypomagnesemia...
Diagnosis?
Ventricular fibrillation
Chaotic rhythm with
wide QRS
Causes: terminal
rhythm in cardiac
arrest
70 bpm• Rate?
• Regularity? regular
flutter waves
0.06 s
• P waves?
• PR interval? none
• QRS duration?
Interpretation? At...
Atrial Flutter
Deviation from NSR
 No P waves. Instead flutter waves (note
“sawtooth” pattern) are formed at a rate of
25...
QUESTIONS
1. 2 year old with syncope and VT
LONG QT SYNDROME
Intervals
PR and QRS durations are relatively short from birth to
age 1 and gradually lengthen during childhood; corrected...
LONG QT SYNDROME
LONG QT – SYNDROME.
N-QTc- Infants 0.44 & NB-0.49sec
1. Beta-Blockers .Avoid drugs known to prolong
QT-interval , electrol...
14-year old girl
•Asymptomatic now
•Intermittent palpitations, no syncope
•SO2: 94%
•Split S2, multiple heart sounds, no
m...
EBSTEIN ANOMALY
Sinus, Tall P, splintered QRS
CASE 3 DILATED CARDIOMYOPATHY
There is marked LVH (S wave in V2 > 35
mm) with dominant S waves in V1-4.
Right axis deviation suggests associated
right v...
4. INTRPREAT ECG
H
Y
P
E
R
K
A
L
E
M
I
A
• Changes appear when K+ falls below about 2.7
mmol/l
• Increased amplitude and width of the P wave
• Prolongation of the ...
WPW SYNDROME6.
69
Delta wave
•WPW- 3 features
•Short PR interval ,
•Delta wave on upstroke of QRS
•Slightly wide QRS
Station 1.a 1 day old neonate with respiratory distress ECG done
What are ECG features?
What is diagnosis?
What disorders ...
Inverted p/t wave, -ve qrs in lead 1.lead 2 n 3
reversed.lead 2 resemble 3 and 3 resemble 2
DEXTROCARDIA
number of bowel, ...
ATRIAL FIBRILLATION8.
Atrial activity
is chaotic
Station No;9
A 10 day old newborn was rushed to NICU by a local doctor as he found
different pattern of his cardiac activi...
A)COMPLETE HEART BLOCK
b) Neonatal Lupus
c) Transfer of anti Ro antibodies between 12-16
wks of gestation
d) Cardiac pacin...
10
2 months old baby admitted with recurrent cough
cold, irritability, dyspnea and sweating. EKG done
What is the diagnosi...
Answer
ALCAPA
Inverted T wave, V5-V6 deep Q wave,ST
elevation , inverted T wave
Cardiac catherization
Medical t/ t for CCF...
ALCAPA_ECG # Description : ECG. Left axis deviation with left
ventricular hypertrophy. Signs of anterolateral myocardial i...
A 12 yr old male child with c/o jt pain and fever admitted in ER.ECG
done showed.
What does this EKG strip shows (1)
Name ...
Answer
RHEUMATIC PERICARDITIS
Low voltage QRS, elevation of ST, Twave
inversion
Friction Rub and Pulsus Paradoxus
steroid
...
PERICARDITIS
Diffuse upsloping ST segment elevations seen
best here in leads II, III, aVF, and V2 to V6
12
MYOCARDITIS
Sinus tachycardia with non-specific ST segment changes
13
14
Name the wave marked by the asterisk
In which condition will you find it?
Which serious arrhythmia can it lead to?
How wil...
J WAVE,OSBORNE WAVE
Hypothermia
Ventricular arrhythmia
Rewarm the patient
ECG showing R wave in lead V1 with RS in V2 (sudden transition),
Right axis deviation , no q waves in lateral leads sugges...
PERICARDIAL EFFUSION
Sinus tachycardia with low QRS voltage and QRS
alternans
16
ASD
There is right axis deviation with tall R waves
V1-3 and corresponding deep S waves in V4-6. T waves are flat in
V1 an...
VSD
The Katz-Wachtel sign is tall diphasic RS complexes at
least 50 mm in height in lead V2, V3 or V4 – mid
precordial lea...
PREMATURE BEATS
Premature Ventricular
Contraction
Premature Atrial
Contraction
Normal Variants
Sinus arrythmia
 Can be quite marked
 Slows on expiration and
speeds up on inspiration
Extrasystoles
 C...
The Pediatric ECG…
In Summary
Consider the age of the child, and the
cardiac forces that may be dominant
Use a structured approach and assess...
Pe
Upcoming SlideShare
Loading in …5
×

Pe

9,483 views
10,340 views

Published on

2 Comments
14 Likes
Statistics
Notes
No Downloads
Views
Total views
9,483
On SlideShare
0
From Embeds
0
Number of Embeds
7,170
Actions
Shares
0
Downloads
258
Comments
2
Likes
14
Embeds 0
No embeds

No notes for slide

Pe

  1. 1. The Pediatric ECG DR. ATUL KULKARNI MD DR MANDAR HAVAL DCH DNB
  2. 2. Objectives Review the cardiac physiology with respect to age, and age related normals Discuss wave morphology and axis as it relates to age and ventricular dominance Review intervals and other “differences” in the pediatric ECG Discuss an approach to interpretation of chamber enlargement Review some basic tachyarrythmias common in children Normal variants and osce on ECG
  3. 3. Background ECG changes during the first year of life reflect the switch from fetal to infant circulation, changes in SVR, and the increasing muscle mass of the LV The size of the ventricles changes as the infant grows into childhood and adulthood The RV is larger and thicker at birth because of the physiologic stresses on it during fetal development By approximately 1 month of age, the LV will be slightly larger By 6 months of age, the LV is twice the size of the RV, and by adolescence it is 2.5 times the size
  4. 4. Heart rate  Average heart rate peaks at second month of life, then gradually decreases  Resting HRs start at 140 bpm at birth, fall to 120 bpm at 1 year, 100 bpm at 5 years, and adult ranges by 10 years
  5. 5. • INTRINSIC HEART RATES Newborn to 3 years: • SA node 95 – 120 • AV node (junctional) 45 – 85 • Purkinje (ventricular) 35 – 55 3 years to teenager • SA node 55 – 120 • AV node (junctional) 35 – 65 • Purkinje (ventricular) 25 ‐ 45
  6. 6. Age Related Normal Findings Tables exists that include age based normal ranges for heart rate, QRS axis, PR and QRS intervals, and R and S wave amplitudes After infancy, changes become more subtle and gradual as the ECG becomes more like that of an adult
  7. 7. The P Wave Best seen in leads II and V1 P wave amplitude does not change significantly during childhood Amplitudes of 0.025 mV should be regarded as approaching the upper limit of normal
  8. 8. The QRS Complex QRS complex duration is shorter, presumable because of decreased muscle mass QRS complexes > 0.08 sec in patients < 8 years is pathologic In older children and adolescence a QRS duration > 0.09 sec is also pathologic
  9. 9. The T Wave The T waves are frequently upright throughout the precordium in the first week of life Thereafter, T waves in V1-V3 invert and remain inverted from the newborn period until 8 years of age This is called the “juvenile T wave pattern”, and can sometimes persist into adolescence Upright T waves in the right precordial leads in children can indicate right ventricular hypertrophy
  10. 10. 3 day old & 7 y/o
  11. 11. QRS Axis and Ventricular Dominance At birth, the axis is markedly rightward (+60 - +160), the R/S ratio is high in V1 and V2 (large precordial R waves), and low in V5 and V6 As the LV muscle mass grows and becomes dominant the axis gradually shifts (+10 - +100) by 1 year of age, and the R wave amplitude decreases in V1 and V2 and increases in V5 and V6
  12. 12. What is the axis?
  13. 13. What is the axis? LAD Normal RA D Lead I AVF Negative + + _ Lead I AVF Normal Positive Positive RAD Negative Positive LAD Negative Negative
  14. 14. What is the axis? RIGHT AXIS DEVEATION
  15. 15. What is the axis? LAD
  16. 16. What is the axis? NORMAL
  17. 17. CHAMBER HYPERTROPHY
  18. 18. Interpretation? Right atrial enlargement
  19. 19. DIGNOSIS? Left atrial enlargement
  20. 20. Atrial Enlargement RAE is diagnosed in the presence of a peaked tall P wave in II In the first 6 months, the P wave must be >3 mm to be pathologic; then >2 mm is abN LAE can be diagnosed with a biphasic P wave in V1 with a terminal inferior component The finding of a notched P wave in II can be a normal variant in 25% of pediatric ECGs
  21. 21. Interpretation? Right ventricular hypertrophy (RVH)
  22. 22. RVH Large R wave in V1 and large S wave in V6 Upright T wave in V1-V3 RAD Persistent pattern of RV dominance Right Ventricular Hypertrophy Diagnosis depends on age adjusted values for R wave and S wave amplitudes A qR complex or rSR’ pattern in V1 can also be seen Upright T waves in the right precordial leads, RAD, and complete reversal of adult precordial pattern of R and S waves all suggest RVH Lead V1with the R height > 15 mm IN < 1YR & >10mm IN > 1 YR
  23. 23. RVH
  24. 24. Interpretation? Left ventricular hypertrophy (LVH)
  25. 25. LVH R wave > 98th percentile in V6 and S wave > 98th percentile in V1 LV “strain” pattern in V5 and V6 or deep Q waves in left precordial leads “Adult” precordial R wave progression in the neonate
  26. 26. CONDUCTION ABNORMALITIES Bundle branch blocks are diagnosed as they would be in adults; RBBB occurs most commonly after repair of congenital heard defects and LBBB is very rare First degree AV block and Mobitz type 1 (Wenckebach) can be a normal variant in 10% of kids Complete AV block is usually congenital or secondary to surgery
  27. 27. Sinus Bradycardia Deviation from NSR - Rate < 60 bpm  Etiology: SA node is depolarizing slower than normal, impulse is conducted normally (i.e. normal PR and QRS interval).
  28. 28. Sinus Tachycardia Deviation from NSR - Rate > 100 bpm Etiology: SA node is depolarizing faster than normal, impulse is conducted normally. Remember: sinus tachycardia is a response to physical or psychological stress, not a primary arrhythmia.
  29. 29. Interpretation? Sinus Tachycardia
  30. 30. 1st Degree AV Block Etiology: Prolonged conduction delay in the AV node or Bundle of His.
  31. 31. Diagnosis? p 1st Degree AV Block
  32. 32. FIRST DEGREE HEART BLOCK PR interval > 5 small divisions, 0.2 secs Causes: myocarditis, acute rheumatic fever, drugs,
  33. 33. 50 bpm• Rate? • Regularity? regularly irregular nl, but 4th no QRS 0.08 s • P waves? • PR interval? lengthens • QRS duration? Interpretation? 2nd Degree AV Block, Type I
  34. 34. 2nd Degree AV Block, Type I Deviation from NSR  PR interval progressively lengthens, then the impulse is completely blocked (P wave not followed by QRS).
  35. 35. 40 bpm• Rate? • Regularity? regular nl, 2 of 3 no QRS 0.08 s • P waves? • PR interval? 0.14 s • QRS duration? Interpretation? 2nd Degree AV Block, Type II
  36. 36. 2nd Degree AV Block, Type II Deviation from NSR  Occasional P waves are completely blocked (P wave not followed by QRS).  Etiology: Conduction is all or nothing (no prolongation of PR interval); typically block occurs in the Bundle of His. MOBITZ TYPE 2
  37. 37. Rhythm #13 40 bpm• Rate? • Regularity? regular no relation to QRS wide (> 0.12 s) • P waves? • PR interval? none • QRS duration? Interpretation? 3rd Degree AV Block
  38. 38. Diagnosis? 3rd Degree AV Block
  39. 39. Diagnosis? RBBB
  40. 40. RIGHT BUNDLE BRANCH BLOCK Wide QRS > 0.12 s ( 3 small divisions) M morphology in V1 V1 “Rabbit Ears”
  41. 41. Diagnosis? LBBB
  42. 42. LEFT BUNDLE BRANCH BLOCK Wide QRS > 0.12 s ( > 3 small divisions) M morphology in V 6 and W in V1
  43. 43. ARRHYTHMIAS
  44. 44. 13 y/o with palpitations Paroxysmal supraventricular tachycardia (PSVT)
  45. 45. 22 day old with poor feeding Paroxysmal supraventricular tachycardia (PSVT)
  46. 46. Diagnosis? Paroxysmal supraventricular tachycardia (PSVT)
  47. 47. Paroxysmal supraventricular tachycardia (PSVT) Regularity: Regular Rate : >180/min P wave morphology: Different from sinus P wave or lost in preceeding T wave PR interval: 0.12 – 0.20 secs ( normal) QRS interval: normal (<0.08 s) Pattern: Sudden onset and offset
  48. 48. Diagnosis What is the rate? Is the QRS wide or narrow? Causes Ventricular tachycardia
  49. 49. Ventricular tachycardia Rate > 120 / min QRS > 0.08 secs Causes: myocarditis, LCAPA, tumour, Long QT, drugs, surgery
  50. 50. Diagnosis? Torsades de pointis
  51. 51. Torsades de pointis
  52. 52. Torsades de pointis Gradual change in amplitude of QRS Rate 150-250/min Prolonged QT interval, Hypokalemia, hypomagnesemia, drugs
  53. 53. Diagnosis?
  54. 54. Ventricular fibrillation Chaotic rhythm with wide QRS Causes: terminal rhythm in cardiac arrest
  55. 55. 70 bpm• Rate? • Regularity? regular flutter waves 0.06 s • P waves? • PR interval? none • QRS duration? Interpretation? Atrial Flutter
  56. 56. Atrial Flutter Deviation from NSR  No P waves. Instead flutter waves (note “sawtooth” pattern) are formed at a rate of 250 - 350 bpm.  Only some impulses conduct through the AV node (usually every other impulse).
  57. 57. QUESTIONS
  58. 58. 1. 2 year old with syncope and VT LONG QT SYNDROME
  59. 59. Intervals PR and QRS durations are relatively short from birth to age 1 and gradually lengthen during childhood; corrected QT (QTc) should be calculated on all pediatric ECGs During the first 6 mo of life, the QTc is slightly longer and is considered normal below 0.49 sec After that, any QTc above 0.44 sec is abnormal Other features of long QT syndrome include notched T waves, abnormal U waves, relative bradycardia and T wave alternans
  60. 60. LONG QT SYNDROME
  61. 61. LONG QT – SYNDROME. N-QTc- Infants 0.44 & NB-0.49sec 1. Beta-Blockers .Avoid drugs known to prolong QT-interval , electrolyte imbalance. 2. SOS pacemaker . W/F Syndromes associated with Long QT-interval. 3. Avoid competitive sports and swimming, teach CPR to the caretakers. Inform about SIDS.
  62. 62. 14-year old girl •Asymptomatic now •Intermittent palpitations, no syncope •SO2: 94% •Split S2, multiple heart sounds, no murmurs CASE 2
  63. 63. EBSTEIN ANOMALY Sinus, Tall P, splintered QRS
  64. 64. CASE 3 DILATED CARDIOMYOPATHY
  65. 65. There is marked LVH (S wave in V2 > 35 mm) with dominant S waves in V1-4. Right axis deviation suggests associated right ventricular hypertrophy (i.e. biventricular enlargement). There is evidence of left atrial enlargement (deep, wide terminal portion of the P wave in V1). There are peaked P waves in lead II suggestive of right atrial hypertrophy (not quite 2.5mm in height).
  66. 66. 4. INTRPREAT ECG H Y P E R K A L E M I A
  67. 67. • Changes appear when K+ falls below about 2.7 mmol/l • Increased amplitude and width of the P wave • Prolongation of the PR interval • T wave flattening and inversion • ST depression • Prominent U waves (best seen in the precordial leads) • Apparent long QT interval due to fusion of the T and U waves HYPOKALEMIA- ECG 5.
  68. 68. WPW SYNDROME6.
  69. 69. 69 Delta wave
  70. 70. •WPW- 3 features •Short PR interval , •Delta wave on upstroke of QRS •Slightly wide QRS
  71. 71. Station 1.a 1 day old neonate with respiratory distress ECG done What are ECG features? What is diagnosis? What disorders are associated? What precaution to be taken in emergency with such patients 7)
  72. 72. Inverted p/t wave, -ve qrs in lead 1.lead 2 n 3 reversed.lead 2 resemble 3 and 3 resemble 2 DEXTROCARDIA number of bowel, esophageal, bronchial and cardiovascular disorders (such as double outlet right ventricle, endocardial cushion defect and pulmonary stenosis) Kartagener syndrome Place rt Up N lt Lo lead on Up lft N Lo rt
  73. 73. ATRIAL FIBRILLATION8. Atrial activity is chaotic
  74. 74. Station No;9 A 10 day old newborn was rushed to NICU by a local doctor as he found different pattern of his cardiac activity. O/E child had fine rashes over the face specially the periorbital area . ECG done in ER showed (1x5=5) a) What is the ECG diagnosis? b )What is probable diagnosis? c) What is the pathogenesis of this disease? d) What is the Rx of this acute stage? e) What is the earliest age at which this cardiac defect can detected antenatally?
  75. 75. A)COMPLETE HEART BLOCK b) Neonatal Lupus c) Transfer of anti Ro antibodies between 12-16 wks of gestation d) Cardiac pacing e) 16 wks of GA
  76. 76. 10 2 months old baby admitted with recurrent cough cold, irritability, dyspnea and sweating. EKG done What is the diagnosis? (1/2) Name 4 EKG findings that helped u in diagnosis (1) What is the diagnostic test?(1/2) Name treatment options of it.(1)
  77. 77. Answer ALCAPA Inverted T wave, V5-V6 deep Q wave,ST elevation , inverted T wave Cardiac catherization Medical t/ t for CCF, ishamia and Surgical excision and ligation
  78. 78. ALCAPA_ECG # Description : ECG. Left axis deviation with left ventricular hypertrophy. Signs of anterolateral myocardial infarction: deep Q waves with T waves inversions in leads I, avL and deep Q waves with ST elevation in the left precordial leads.
  79. 79. A 12 yr old male child with c/o jt pain and fever admitted in ER.ECG done showed. What does this EKG strip shows (1) Name 3 EKG findings that helped you in diagnosis (1) What are the 2 clinical findings which will indicates severity?(1) Name treatment options of it.(1) What are other differential diagnosis?(1) 11
  80. 80. Answer RHEUMATIC PERICARDITIS Low voltage QRS, elevation of ST, Twave inversion Friction Rub and Pulsus Paradoxus steroid Viral Pericarditis, Benign Pericarditits, JRA
  81. 81. PERICARDITIS Diffuse upsloping ST segment elevations seen best here in leads II, III, aVF, and V2 to V6 12
  82. 82. MYOCARDITIS Sinus tachycardia with non-specific ST segment changes 13
  83. 83. 14
  84. 84. Name the wave marked by the asterisk In which condition will you find it? Which serious arrhythmia can it lead to? How will you treat it?
  85. 85. J WAVE,OSBORNE WAVE Hypothermia Ventricular arrhythmia Rewarm the patient
  86. 86. ECG showing R wave in lead V1 with RS in V2 (sudden transition), Right axis deviation , no q waves in lateral leads suggesting decreased pulmonary blood flow TETROLOGY OF FALLOT (TOF)15
  87. 87. PERICARDIAL EFFUSION Sinus tachycardia with low QRS voltage and QRS alternans 16
  88. 88. ASD There is right axis deviation with tall R waves V1-3 and corresponding deep S waves in V4-6. T waves are flat in V1 and inappropriately upright in V2-3. There is the RsR' pattern in V1 of partial rightbundle branch block. 17
  89. 89. VSD The Katz-Wachtel sign is tall diphasic RS complexes at least 50 mm in height in lead V2, V3 or V4 – mid precordial leads 18
  90. 90. PREMATURE BEATS Premature Ventricular Contraction Premature Atrial Contraction
  91. 91. Normal Variants Sinus arrythmia  Can be quite marked  Slows on expiration and speeds up on inspiration Extrasystoles  Can be atrial or venticular and are usually benign in the context of a structurally normal heart; typically monomorphic and associated with slower heart rates  Abolish with excercise
  92. 92. The Pediatric ECG…
  93. 93. In Summary Consider the age of the child, and the cardiac forces that may be dominant Use a structured approach and assess morphology, axis, and intervals in the context of age related normals Evaluate for the presence of structural disease Remember the “normal variants”

×