ABC of Pediatric ECG's

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Pediatric ECGs are more challenging to read as copmpared to adult ECGs. Here is basic to details of Pediatric ECG's.

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ABC of Pediatric ECG's

  1. 1. ABC’s of ECGVIKAS KOHLI MD (Pediatrics) FAAP FACC Senior Consultant Pediatric Cardiology Indraprastha Apollo Hospital
  2. 2. DETERMINATION OF RATE 100 300 150 75
  3. 3. AVF
  4. 4. 2 YR OLD CHILD
  5. 5. 1 MO OLD CHILD
  6. 6. P WAVE
  7. 7. P WAVE
  8. 8. LEFT ATRIALENLARGEMENT
  9. 9. RIGHT ATRIAL ENLGMNT
  10. 10. LOOK AT THE PR INTVERAL FIRST DEGREE HEART BLOCK
  11. 11. QRS COMPLEX
  12. 12. rSR’
  13. 13. RBBB
  14. 14. RBBB
  15. 15. RBBB
  16. 16. LBBB
  17. 17. QT INTERVAL
  18. 18. RRQTc = QT/√RR QT
  19. 19. LONG QT SYNDR
  20. 20. TYPES OF LONG QT
  21. 21. ROMANO WARD SYNDROME ChromosLQTS Mutated omal Ion Current AffectedType Gene LocusLQT1 11p15.5 KVLQT1) Potassium current (IKs)LQT2 7q35-36 HERG Potassium current (IKr)LQT3 3p21-24 SCN5A Sodium current (INa)LQT4 4q25-27 ? ? KCNE1 21q22.1-LQT5 (heterozy Potassium current (IKs) 22.2 gotes) 21q22.1-LQT6 MiRP1 Potassium current (IKr) 22.2
  22. 22. Jarvell & Lang Nielsen LQTS Chromosomal Ion Current Mutated Gene Type Locus Affected KVLQT1 (KCNQ1) Potassium current JLN1 11p15.5 (homozygot (IKs) es) KCNE1 Potassium current JLN2 21q22.1-22.2 (homozygot (IKs) es)
  23. 23. Long QT Syndrome• 1 in 3000 incidence in population• Females > Males; Postpartum; Menses• Syncope• Arrhythmia induced by Sound, Cold water, exercise, emotion• Sodium channel blockers in LQT3, potassium supplementation with spironolactones in LQT2: Clinical trials
  24. 24. ST SEGMENT
  25. 25. ST SEGMENT DEPRESSION V3-V5
  26. 26. T INVERSION V5-V6
  27. 27. ST T ABNORMALITIES
  28. 28. ST T INVERSION V3-V6
  29. 29. VENTRICULARHYPERTROPHY
  30. 30. NOMOGRAMS
  31. 31. 5 Y OLD CHILD R=18 IN V1; ULN=14:RVH T IS UPRIGHT IN V1
  32. 32. 8 YR MALE R=14;ULN=12 T IS INVERTED IN V1
  33. 33. 1 WEEK OLD: T WAVE FLAT RVH (T WAVE CRITERIA): TGA
  34. 34. RVH IN NEWBORN• T UPRIGHT (+) IN V1 TILL DAY #5• BY DAY #5 T SHOULD INVERT/BE FLAT• IF T STILL POSITIVE IN V1 BY DOL#5 THEN RVH
  35. 35. LVH
  36. 36. LVH
  37. 37. 2 DAY OLD BABY WMURMUR LVH; LAD: COMPLEX CONG HEART DSS
  38. 38. THUMB RULES FOR RVH/LVH• RVH IN NEWBORNS – R in V1> 25 mm• RVH IN 1ST YR – R in V1> 20 mm• LVH IN NEWBORNS – R in V6> 12 mm• LVH ANY OTHER TIME – R in V6> 25 mm
  39. 39. RHYTHM PROBLEMSBRADYCARDIAS
  40. 40. SINUS BRADYCARDIA
  41. 41. FIRST DEGREE HEART BLOCK
  42. 42. COMPLETE AV DISSOCIATION
  43. 43. COMPLETE HEART BLOCK
  44. 44. HYPO K: BRADY W ST-T
  45. 45. 2:1
  46. 46. RHYTHM PROBLEMS TACHYCARDIA:NARROW COMPLEX
  47. 47. NARROW COMPLEX
  48. 48. AVNRT NOW SINUS
  49. 49. WPW
  50. 50. WPW
  51. 51. AF
  52. 52. AF W 2:1
  53. 53. VT
  54. 54. VT ? AF W ACCESORY PATHWAY
  55. 55. VT Vs SVT
  56. 56. BIGEMINY
  57. 57. COUPLETS
  58. 58. SALVOS
  59. 59. TdP; DC SHOCK; SINUS
  60. 60. TdP PVC
  61. 61. VT; VFIB
  62. 62. Torsade de Pointes (TdP)
  63. 63. VT Vs SVT
  64. 64. WIDE COMPLEX TACHY
  65. 65. WIDE COMPLEX VT
  66. 66. PACEMAKER
  67. 67. Hi K
  68. 68. ELECTRICAL ALTERNANS
  69. 69. Q IN AVL: ALCAPA
  70. 70. YOUR OPINION
  71. 71. AVNRT Vs JUNCTIONAL
  72. 72. PT WITH CARDIAC ARREST &VFIB: RECOVERED BRUGADA SYNDR
  73. 73. 12 yr old boy Hx palpitation
  74. 74. Searching for p waves gives theanswer
  75. 75. PEDS CARDIO TRAININGMODULE• 4 HOUR SESSION TO RE-TRAIN PEDS PRACTITIONERS IN:• AUSCULTATION• READING ECG• CARDIAC XRAYS• UNDERSTANDING ECHO REPORT• WHEN TO OPERATE• NEONATAL CARDIO• CONTACT 989136223
  76. 76. AF W COMPL H BLOCK
  77. 77. AF W BLOCK

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