Pediatric normal ecg
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The ECG of children is different from adults due to developmental changes. As children age, their heart rate decreases while measurements like P-wave duration and QRS duration increase. In newborns, the right ventricle dominates but over the first year the left ventricle becomes the dominant chamber. The T-wave also changes significantly in infants in the first week of life as right ventricular pressure changes. Premature infants have shorter ECG intervals and less right ventricular dominance compared to full-term infants.
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This document discusses electrocardiograms (ECGs), including how to properly record and evaluate them and how to diagnose cardiac conditions with the help of ECGs along with clinical findings. It provides guidance on evaluating features of ECGs like rates, intervals, axes, and rhythms. It emphasizes that ECGs should not be used alone for diagnosis and must be considered together with a patient's clinical presentation and history. It also presents several case studies of pediatric cardiac patients and asks the reader to make a diagnosis based on the ECG and clinical findings provided.
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Basic ecg in paediatrics, arrythmias, Norma and abnormal ecg, left and right ventricular hypertrophy, atrial dilatation
The ECG in chmaber enlargement final.pptx
The document discusses electrocardiogram (ECG) findings associated with cardiac chamber enlargement. It notes that while ECG is not very sensitive, it can provide clues about underlying heart conditions. Enlargement of cardiac chambers on ECG is seen through changes in wave morphology, amplitude, axis, and duration. Specific criteria are discussed to identify left and right atrial abnormalities as well as left and right ventricular hypertrophy on ECG. Limitations of ECG criteria in the presence of conduction abnormalities are also reviewed.
ECG-cases.pptx
This document contains an ECG report that summarizes various cardiac conditions including:
1) Ischemic heart diseases such as ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI).
2) Tachyarrhythmias such as sinus tachycardia, supraventricular tachycardia, atrial fibrillation, and atrial flutter.
3) Bradyarrhythmias including junctional escape rhythm and sinus arrest.
4) Ventricular hypertrophy of the left and right ventricles.
5) Bundle branch blocks including left and right bundle branch blocks.
6) Premature complexes including premature atrial, junctional, and
cardiac hypertrophy
The document discusses atrial and ventricular enlargement and how it appears on ECGs. It describes dilation and hypertrophy as two types of cardiac enlargement. It then examines right and left atrial abnormalities and how they change the P wave. Next it analyzes right and left ventricular hypertrophy, identifying criteria for each like tall R waves in certain leads. It notes causes can include things like pulmonary disease or valve problems. Examples of ECGs demonstrating various types of enlargement are presented and criteria are reviewed.
Basics of ECG.pptx
This document provides an overview of basics of ECG interpretation. It discusses the history and development of ECG, conduction pathways, standardization, waves and intervals including P wave, PR interval, QRS complex, QT interval, axis determination, and abnormalities indicative of conditions like LVH and RVH. Pediatric ECG variations from adult ECG are also summarized. The document is intended as an educational guide on ECG interpretation for medical professionals.
Shadechapter14.ppt [read only]
- Hypertrophy is a thickening of the ventricular wall, while dilation is an enlargement of a chamber to accommodate increased blood volume. Enlargement affects the atria, while hypertrophy affects the ventricles.
- The P wave is used to identify atrial enlargement, while changes in the QRS complex indicate ventricular hypertrophy. Increased duration, amplitude or axis deviation serve as indicators.
- Right atrial enlargement increases the first part of the P wave amplitude. Left atrial enlargement increases the terminal P wave amplitude in V1 and the P wave duration.
Hocm
This document summarizes ECG manifestations in hypertrophic cardiomyopathy (HCM). Key findings include ventricular hypertrophy affecting different regions of the heart, intraventricular conduction defects, and left and/or right atrial abnormalities. Specific ECG patterns indicate septal, left ventricular, and right ventricular hypertrophy. ECG changes in HCM commonly include left ventricular hypertrophy, left atrial abnormality, pathological Q waves, and prolonged QT interval. The ECG is useful for screening populations for HCM when echocardiography is not available.
Interpretation of ecg_in_pulmonary_disease
This document discusses ECG findings in patients with pulmonary diseases such as chronic obstructive pulmonary disease (COPD) and pulmonary embolism (PE). It describes changes seen in COPD such as right axis deviation, low voltage complexes, and right ventricular hypertrophy. It also outlines typical findings in PE including sinus tachycardia, right ventricular strain pattern, complete or incomplete right bundle branch block, and S1Q3T3 pattern. The document provides details on diagnostic criteria for right atrial enlargement, right ventricular hypertrophy, and right bundle branch block.
TCAD - Multi-lead ECG
This document provides guidance on performing and interpreting multi-lead electrocardiograms (ECGs). It aims to improve patient outcomes by reducing time to percutaneous coronary intervention through early ECG acquisition and transmission. Proper lead placement is emphasized for 12- and 15-lead ECGs. A systematic approach to ECG interpretation is outlined, including identifying the underlying rhythm, assessing the axis and potential hemiblocks or bundle branch blocks, using the ISAL method to determine infarct location, and evaluating for atrial abnormalities. Key waves, intervals, and criteria for identifying ventricular tachycardia, ischemia, injury, and infarction are defined.
7th part ECG Basics: ECG changes in IHD Dr Salah Mabrouk
This document provides information on ECG changes seen in ischemic heart disease. It discusses the blood supply of the heart and how different coronary artery occlusions can cause specific ECG changes. These include ST segment elevation or depression, T wave changes, and pathologic Q waves indicating injury, ischemia or necrosis in different heart regions. Examples are provided of ECG tracings demonstrating myocardial infarction patterns involving the inferior, lateral, anterior and posterior walls. It also discusses non-Q wave infarction and pseudoinfarction ECG patterns that can mimic myocardial injury. The effects of conditions like electrolyte abnormalities, drugs, and cardiac syndromes on the ECG are summarized.
How to read ECG
The document provides information on how to read and interpret an electrocardiogram (ECG). It discusses the components of an ECG including the leads, waves, intervals and segments. It describes how to analyze key aspects such as heart rate, rhythm, axes, hypertrophy, blocks, and abnormalities. The systematic 14-point approach involves analyzing standardization, rate, rhythm, P waves, intervals, voltages, axes, and segments to interpret the ECG and identify any pathological conditions.
Similar to Pediatric normal ecg (20)
7th part ECG Basics: ECG changes in IHD Dr Salah Mabrouk
7th part ECG Basics: ECG changes in IHD Dr Salah Mabrouk
More from Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIAS
PEDIATRIC SUDDEN CARDIAC DEATH, SYNCOPE, INHERITABLE ARRHYTHMIASDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Syncope refers to a sudden, transient loss of consciousness due to decreased blood flow to the brain. In children and adolescents, cardiac abnormalities causing syncope are rare, and the most common causes are autonomic syncope, vasovagal syncope, and postural hypotension. Evaluation of syncope in children aims to determine if there is an increased risk of sudden cardiac death. Factors suggesting a cardiac cause include lack of prodrome, palpitations, exercise-induced syncope, family history of cardiac issues or early death, and prior known cardiac disease. These patients should be referred to a cardiologist to evaluate for potential inherited cardiac conditions like Brugada syndrome or long QT syndrome.FETAL CARDIAC SCREENING
The document outlines a talk on fetal cardiac screening. It discusses the impact of screening from both a health and parental perspective. Screening allows for planning delivery at centers equipped for any needed care. It can identify life-threatening conditions for in utero treatment or help avoid unnecessary post-birth testing and transport. Parents benefit from informed decisions and preparation. The talk explores current practices and potential future directions for improving screening.
SYNCOPE, SUDDEN CARDIAC DEATH AND INHERITED ARRHYTHMIAS
This document discusses syncope in children and adolescents, providing definitions of syncope and sudden cardiac death. It notes that cardiac abnormalities are a rare cause of syncope in children unlike in adults. Various types of autonomic syncope are described including vasovagal, postural hypotension, and dyautonomia. Evaluation for cardiac syncope is recommended to determine risk of death. Specific cardiac conditions like Brugada syndrome, long QT syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia are discussed. The take home message is to consider arrhythmias with any exertional or unexplained syncope and to evaluate family history of sudden cardiac death or arrhythmias.
PEDIATRIC CARDIOLOGY CASE SCENARIOS
This document discusses two case scenarios involving pediatric cardiology patients. The first scenario is about a 12-year-old boy who is overweight due to a sedentary lifestyle involving online schooling, TV watching, and eating fast and junk food. The second scenario describes a 14-year-old active boy whose grandfather died at age 49 and who has elevated cholesterol and LDL levels. The document discusses the long-term cardiovascular risks of obesity and high cholesterol in childhood, including increased blood pressure, lipids, and future risk of atherosclerosis. It recommends addressing these risks through lifestyle changes, physical activity, healthy eating, and early screening and treatment when needed, including behavioral interventions and statin prescriptions in rare cases of familial hyper
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL)
PERCUTANEOUS DEVICE CLOSURE OF AORTO- PULMONARY WINDOW (RESIDUAL) Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the percutaneous closure of a residual aortopulmonary window in a 2-year-old boy using a second occlusion device. The boy was originally treated for an aortopulmonary window at 2 months of age, but follow up showed a residual 4mm window. A second device, an ADO-II 6x6, was successfully deployed above the original device with no residual shunt seen. The boy was discharged the next day with both devices in position and no complications. The summary demonstrates the feasibility of using a second occlusion device to treat residual defects after an initial device closure procedure.LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASESDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
Long term Post operative care of a child with CHD involves monitoring for potential issues like reintervention due to lesion recurrence, arrhythmias, and thromboembolism. It also requires assessing schooling, neurodevelopment, exercise capacity, and providing guidance on marriage, pregnancy, and contraception. Children with repaired lesions are most at risk for reintervention and arrhythmias compared to those with completely corrected or palliated lesions. While outcomes have improved, lifelong multidisciplinary care is generally needed due to the risk of ongoing medical, developmental, and social issues.WHEN TO REFER TO A PEDIATRIC CARDIOLOGIST
This document discusses the timing of interventions for congenital heart defects (CHDs) in pediatric patients. It involves balancing factors like hemodynamic severity, natural history of the defect, procedural outcomes, and institutional experience. There is a trend toward early correction which avoids adverse consequences and is now feasible and realistic in Indian centers with excellent results. The document then discusses scenarios involving ventricular septal defects, atrial septal defects, and patent ductus arteriosus, when intervention is recommended based on symptoms, size of defect, and age/weight of the patient. It notes most CHDs can now be corrected with long-term survival and without need for reintervention in 85-90% of cases.
WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTION
WHEN TO REFER A CHILD TO A PEDIATRIC CARDIOLOGIST FOR INTERVENTIONDr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the timing of interventions for various congenital heart defects (CHDs) in pediatric patients. It provides several case scenarios to illustrate the decision-making process. The key factors in determining when to intervene include the hemodynamic severity of the defect, its predicted natural history, procedural outcomes, and institutional experience. Early correction is generally preferred to avoid complications, and is now feasible in selected centers with excellent results. The document reviews timing guidelines for specific defects such as ventricular septal defects and patent ductus arteriosus. It also describes treatment options such as surgical closure or transcatheter device closure for different CHDs.PEDAITRIC OBESITY AND HYPERLIPEDEMIA
A 12-year-old child is overweight with a BMI of 31 kg/m2 due to a sedentary lifestyle. Obesity increases the risk of high blood pressure, diabetes, and cardiovascular disease over the long term. Management involves promoting outdoor physical activity and healthy eating habits.
A 14-year-old boy has a family history of early death from cardiovascular disease. Though active, he has elevated cholesterol levels placing him at risk for future cardiovascular problems. Early detection and lifestyle modifications can help prevent disease progression.
Screening children's cholesterol levels starting at age 10 and 19 allows for early identification of risk and targeted prevention and treatment approaches like lifestyle changes and low-dose statin therapy for those at highest risk
Micronutrient deficiency In Children
Micronutrient deficiency is common among children globally. At least 50% of children aged 6 months to 5 years suffer from one or more micronutrient deficiencies such as iron, iodine, folate, and vitamin A. The reasons for the high prevalence include inadequate intake of nutritious foods, poor absorption of minerals and vitamins, frequent infections, and consumption of refined foods. Micronutrients play an important role in brain development during the first 1,000 days of life. Complementary feeding starting at 6 months is important to meet increased nutrient needs but current practices in India are often inadequate. Ensuring adequate nutrition through home-made preparations, breastfeeding, and fortified complementary foods can help bridge nutrition
DYSBIOSIS IN CHILDREN BORN BY CAESAREAN SECTION
1. Caesarean section delivery disrupts the normal pattern of microbial colonization in infants, dominating their gut with bacteria from the human skin and oral cavity rather than vaginal and enteric bacteria acquired during a vaginal birth.
2. Microbial dysbiosis resulting from C-section delivery has been associated with increased risk of conditions like asthma, obesity, food allergies, and inflammatory bowel disease later in life.
3. Restoring a healthy gut microbiota in infants born by C-section through breastfeeding and probiotic supplementation may help reduce the risk of these long-term health issues, though more research is still needed.
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?
PEDIATRIC CARDIAC SERVICES IN INDIA: WHERE DO WE ACTUALLY STAND?Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document discusses the current state of pediatric cardiac services in India. It notes that India has a high birth prevalence of congenital heart disease (CHD), with approximately 242,390 children born with CHD each year. However, the availability of advanced cardiac care is very limited, with only 9 high-volume centers performing over 500 surgeries per year. While an estimated 43,000 children are born annually with serious forms of CHD requiring treatment, only around 8,500 (20%) currently receive optimal cardiac care. The document outlines several challenges facing the improvement and expansion of pediatric cardiac services in India, including limited resources, infrastructure, and trained staff. It proposes various strategies to address these issues, such as establishing more specializedHeart diseases in children
1. Heart diseases in children, specifically congenital heart diseases (CHDs), are not as rare as once thought, occurring in 8-10 out of every 1,000 live births and representing the most common birth defect.
2. CHDs can present in a variety of ways from cyanosis and congestive heart failure in neonates to symptoms appearing later in childhood. Determining if a CHD is present, whether it involves cyanosis, and the specific malformation involved requires consideration of various clinical criteria and tests.
3. Proper diagnosis and management is important as some CHDs depend on persistent ductal circulation after birth for survival, requiring treatment with prostaglandins to keep the ductus arteriosus
ICCU ECGs
1. A 65-year-old woman presented with a fall and hip fracture. Her ECG showed complete heart block with a ventricular rate of 45 beats per minute, requiring a permanent pacemaker.
2. A 50-year-old woman with rheumatic heart disease was in atrial fibrillation with a controlled ventricular rate of 60-65 beats per minute on her ECG. The ECG showed signs of digoxin use and possible hypokalemia, requiring questions about appetite and potassium levels.
3. A 20-year-old woman presented with chest pain and her ECG showed a pattern consistent with Wolff-Parkinson-White syndrome type B with right posterior accessory pathway location
CONGENITAL HEART DISEASES: A SIMPLIFIED APPROACH
This document provides an overview of congenital heart diseases (CHDs):
1. CHDs are defects in heart structure and function that exist at birth, though symptoms may not appear until childhood or later. They occur in approximately 1% of live births and are a leading cause of birth defect mortality.
2. CHDs can be acyanotic (without cyanosis) or cyanotic (with cyanosis) and include defects such as ventricular septal defects (VSD), atrial septal defects (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot, and transposition of the great arteries.
3. While the exact causes of most CHDs are unknown
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...
Examination of Cardio Vascular System (CVS): Pediatrics+ APPROACH TO A CHILD ...Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
This document provides an overview of examining the cardiovascular system in pediatric patients and approaching a child with suspected congenital heart disease (CHD). It discusses taking a history, performing a general physical exam, assessing vital signs, inspecting the precordium, palpating pulses and heart sounds, and auscultating for murmurs. The key steps in approaching a child with possible CHD are determining if it is cyanotic or acyanotic, assessing pulmonary blood flow and pulmonary artery pressure, and identifying any duct-dependent lesions.TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...
TACHYPNIC NEOANTE: IS IS A CHD: APPROACH TO A CHILD WITH CONGENITAL HEART DIS...Dr. Murtaza Kamal MD,DNB,DrNB Ped Cardiology
A 2 day old term neonate presented with tachypnea and a heart rate of 90%, raising suspicion of a congenital heart disease (CHD). To determine if the neonate had a CHD, the doctor considered performing a hyperoxia test, applying Nada's criteria, and conducting an echocardiogram. If a CHD was confirmed, the next steps would be to determine if the child had cyanotic or acyanotic heart disease, increased or normal pulmonary blood flow, pulmonary arterial hypertension, and duct dependency to guide referral to a pediatric cardiologist.Cath meet 25020202 (TGA, VSD, PS FOR PA PRESSURES)
- The document summarizes a cardiac catheterization report for a 16-month-old female patient with a history of cyanosis, murmur, and failure to gain weight appropriately who was diagnosed with congenital heart disease.
- Examination findings included cyanosis, low oxygen saturation, murmur, and signs of right ventricular hypertrophy. Previous echocardiogram showed dextro-transposition of the great arteries, ventricular septal defect, and pulmonary stenosis.
- The cardiac catheterization measured pressures in the heart chambers and major vessels. It found elevated pulmonary artery and right-sided heart pressures consistent with pulmonary hypertension. Calculations from the data determined abnormal pulmonary and systemic vascular resistances and a low ratio of
Cath meet 03022020 (VSD PAH FOR REVERSIBILITY, PVR)
- The patient is a 3 year old female with a history of lung infections as an infant and diagnosis of congenital heart disease requiring surgery at age 1 year.
- Examination found signs of right heart enlargement and a loud heart murmur. Echocardiogram showed a large ventricular septal defect with left-to-right shunting and mild pulmonary artery hypertension.
- Cardiac catheterization was performed and found severe pulmonary artery hypertension with right ventricular and pulmonary artery pressures elevated. Oxygen saturations were low in the veins and pulmonary artery.
THALASSEMIA: VENTRICULAR DYSFUNCTION ASSESSMENT
This study assessed 33 multi-transfused thalassemic children with iron overload using tissue Doppler imaging (TDI), strain imaging (SI), and conventional 2D echocardiography compared to 32 healthy controls. While 2D echocardiography showed higher left ventricular dimensions and mass in thalassemic children, ejection fraction and diastolic parameters were normal. TDI velocities were normal at the septum but lower at the lateral wall in thalassemic children. SI and strain rate imaging parameters were significantly lower in thalassemic children across all measured segments. The study concludes that while ejection fraction remains normal with 2D echocardiography, TDI and SI can detect early and regional myocardial involvement not seen with conventional
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LONG TERM OUTCOMES OF POST OPERATIVE CHILD WITH CONGENITAL HEART DISEASES
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Pediatric normal ecg
- 1. ECG IN CHILDREN: HOW IS IT DIFFERENT FROM ADULTS? MURTAZA KAMAL MURTAZA.VMMC@GMAIL.COM 11/SEPT/2018 1
- 2. 2
- 3. DEVELOPMENTAL CHANGES • Decrease in HR • Increase in P-wave duration, PR interval, QRS duration • QRS Voltage: Low during 1st several months • QRS voltages: Low during first several months • Mean QRS axis in frontal plane: Moves from right to left • Increase in PR interval+ QRS duration: Changes in size of heart /AV node 3
- 4. VENTRICULAR DOMINANCE • Newborn: QRS potentials result from RVRV dominance • Transition of ECG from RV dominance at birth to pattern of LV: Lags behind hemodynamic changes • Loss of RV dominance: • Starts at 1 month of age • LV dominance is well established by 1 year 4
- 5. VENTRICULAR DOMINANCE • 1st several weeks: • Tall R+ small S in right and anterior precordium: V3R, V4R, and V1 • Deep S+ small R in left precordium: V6 and V7 • Corresponds to clockwise vector loop in horizontal plane • 2 months of age: • Precordial leads progress to more adult pattern • Deeper S waves in right and taller R waves in left leads • Counterclockwise vector loop in horizontal plane • 1 year: Precordial R wave progression similar to adults 5
- 6. T WAVE CHANGES • Rapid changes of RV pressure after birth: Great effect on T wave • 1st minutes after birth, T-wave vector: Anterior and to left i.e upright in V1+ V6 • May swing rightward in next several hours: Flattening/ inversion of T in left lateral leads 6
- 7. T WAVE CHANGES • Next 7 days: • T-wave vector moves posterior+ leftward • Inverted T in V1+ upright T in V6 • After 7- 8 years: Becomes upright again in V1 • May remain inverted throughout adolescence: Juvenile T-wave pattern 7
- 8. A FEW WORDS ABOUT PRE-TERM INFANT • Notable for its shorter QRS duration, PR interval and QT interval • Less RV dominance at birth than ECG of full-term infant • Precordial voltages: Lower in 1-year-old infant who was premature • Intrinsic myocardial differences of premature or to altered cardiac–torso geometry: Unknown 8
- 9. THANK YOU 9