Story of an 8 years

old boy
PAEDIATRIC ECG INTERPRETATION

@mmgulzar
Aims

 Review approach to ECG interpretations

Appropriate documentation of findings

 Understand what to do with an abnormal ECG

 CURRENLTY
BEING USED
IN VARIOUS
CHI-sites
HOSPITALS

Brisbane
coming soon…….
Indications for Paediatric ECG

 First afebrile seizure

 Syncope
 Chest Pain
 Ingestions - as per Toxbase
 Inappropriate tachycardia or bradycardia
 Diagnosis & management of: arrhythmia, congenital heart disease,
rheumatic fever, Kawasaki’s disease, pericarditis, myocarditis
 Family history of sudden death or life threatening event
 Electrolyte abnormalities
ECG Lead Placement
Electrical System of the Heart
Waves, Segments and Intervals,
ECG Rate

The standard paper speed is 25mm/sec:

 1mm (small square) = 0.04 sec (40ms) 5mm (large square) = 0.2 sec (200ms)
ECG Rate
If rhythm is irregular
What is the Rate?
Rhythm
Sinus Arrhythmia

 Variation in the P-P interval >120 ms (3 small boxes)

 P-P interval gradually lengthens and shortens in a cyclical fashion, usually

corresponding to the phases of the respiratory cycle

 Normal constant sinus P waves & constant P-R interval (no Mobitz I AV

block)
PR Interval
From start of P wave to start of Q wave

 Prolonged PR interval in (>200msec):

 Viral or rheumatic myocarditis and other myocardial
dysfunctions. Certain congenital heart disease
(Ebstein’s, Endocardial cushion defect, ASD),
Digitalis toxicity, ↑K+  
 Short PR interval in: Pre-excitation, with Delta
waves e.g. WPW, glycogen storage disease
 Variable PR int. in: wandering atrial pacemaker, or
(Mobitz type 1) 2nd degree heart block
Wolff Parkinson White Syndrome
 Short PR interval, delta wave & QRS prolongation

Delta waves
 Slurred upstroke of QRS complex
QRS Duration
From start to end of QRS complex

 Prolonged QRS is characteristic of ventricular conduction disturbances:

 Bundle branch blocks, Pre-excitation conditions (e.g. WPW), Intra-ventricular block
QRS Axis

Calculate net deflection in lead 1 and aVF and plot on axis

aVF
QRS Axis
Varies with age

Mean QRS (°)range of QRS (°)

Newborn 125                       
1 wk. to 1 mo. 110 30 – 180
1 mo. to 3 mo 70 10 – 125
3 mo. to 3 yrs. 60 10 – 110
3yr 60 20 – 120
Adult 50 -30 – 105

o Left axis deviation: AVSD, LVH, tricuspid atresia

o Right axis deviation: RBBB, RVH
ST Segment
From end of the QRS complex (j point) to the start of the t wave
T- Waves
Configuration changes over time

 < 1 week of life: T-waves are upright in V1-6

 > 1 week of life: T-waves become inverted in V1-3. If upright ? RVH
 T-wave inversion usually remains until ~ age 8; thereafter the T waves
become upright in V1-3
 However, the juvenile T-wave pattern can persist into adolescence and early
adulthood
 T-waves always upright in V4-V6, if not consider discussion with Cardiology
 Tall, peaked T-waves: hyperkalaemia, LVH (volume overload), benign early
repolarisation
 Flat T-waves: normal newborns, hypothyroidism, hypokalaemia, digitalis,
pericarditis, myocarditis, myocardial ischaemia
 Large, deeply inverted T-waves: raised intracranial pressure (e.g. ICH, TBI)
QT interval: from start of Q wave to end of T wave

 QTc is prolonged: ↓Ca+2, myocarditis, long QT syndromes, head injury or drugs

 QTc is short: ↑Ca+2, digitalis effect, congenital short QT syndrome
ECG Interpretation & Further Action

Depends on:
• History
• Vitals, clinically well/unwell
• Ischemic changes (T wave inversion/ ST segment changes)
• Pronged QT interval, Hx of LOC
• Delta waves, ?palpitations
Abnormal Potassium
Any Questions?

Thankyou!

SHUKRIIA ! ‫کریہ‬44‫ش‬