Pediatric Ecg Flashcards by Isaac Mammen

Heart rate from rhythm strip

Multiply with 6. One paper is 10 sec

Paper is 25 cm long. Paper speed is 25 mm/Sec. Hence..

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1mm in ECG is……..SECONDS

0.04. SECONDS

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Prolonged PR interval in Ped ecg

Ebsteins, ASD, ECD etc, Myocarditis,Hyperkalemia, Digitalis

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Short PR interval in Ped ecg

Glycogen storage disease

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R/S ratio <1 in V6 indicates RVH after ____age

One month

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Highly specific for RVH in Pediatric ECG

qR in V1

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Abnormal Q waves in V5 and V6 in Ped ecg indicate

LVH

Q also indicates Vol overload or MI

Q waves can be normally found in children in V5,6 but not in I aVL

Described in another place as a may be seen in I and aVL

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Inverted T waves in I and aVL in Ped ecg indicate

LV strain pattern

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ECG finding in biventricular hypertrophy in V2-5

Large equiphasic QRS . Also in 2 or more limb leads

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Different implications of Deep Q waves versus Deep and wide Q Waves

Deep and wide-MI and fibrosis. If deep only more s/o Volume overload

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ST segment is judged in relation to ——

TP segment

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T wave finding in first week of life

Upright in all precordial leads

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T wave change after first week of life

T inversion in V1-3

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Tall peaked T waves indicates

Volume overload
Early depolarization
Hyperkalemia

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Large deep inverted T and Neuro

Raised intracranial pressure

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Hypothyroidism and T wave change

Flat T waves

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U waves seen in

Hypokalemia

Sinus Brady

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Most common type of SVT in children

AVRT:

NB:-AVnRT is rarely seen before 2yrs of age. As you age it becomes more common

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Sinus arrhythmias defined as RR Interval variation more than

120 ms or 3 small spaces

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In situs solitus P wave is always positive in

I,II,V4-6

Negative in aVR

Variable in others- Almost always upright in aVF

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Normal P wave axis

30-60

More than 75 is abnormal

More than 90 indicates Situs inversus

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Normally the widest P wave can be upto

100 ms

i.e. 2.5 small divisions
Max amplitude is also 2.5

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Normal PR in a child

110-160 ms: Neonate it is less than 140 ms
Short PR is <100 ms

Adult-120-200ms

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QRS duration is traditionally measured in

Limb leads or V1-2

> 100 ms may be abnormal

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Low voltage QRS means

<5mm in limb leads and<10mm in precordial leads

High voltage limb leads

>20mm in limb leads and >30 mm in precordial leads. | High voltage complexes may be normal

Small q is normally seen in pediatric ecg in

1,aVL,V4-6 and aVF Normal q is <3 mm deep and <1mm wide Q of more than 4 mm is considered abnormal Usually Q is less than 25% of R height

Early transition of QRS

If it occurs in V2

Late transition of QRS

If it happens in V5

Normal QRS axis in children

Upto 1 year:: 90-150 1-8 years:: 45-105 Above 8:: less than 90 Zulfikar

Clockwise loop in pediatric ecg

Q in 2,3,aVF Counter in 1,aVL Anti’s are kept little laterally

RUQ axis and loop

RUQ Axis + clockwise loop=extreme RAD; | If counter clockwise loop= extreme LAD

ST elevation which may be normally seen in young

<1mm in V1-3

Maximum height of normal T

Upto 6 mm in limb leads | Upto 10 mm in precordial leads

T wave in pediatric popl- normal pattern

T UPRIGHT upto 3 days--V3R,V1,V2 From 4th day ---T is INVERTED upto V3 Older children V3 T is usually upright

U wave amplitude

Usually 1/4 of T wave and is positive Repolarisation of His Purkinje system

VT in children

Uncommon in children. Can occur in Long QT syndrome

How to diagnose Biventricular hypertrophy in children

1. Katz Wachtel phenomenon- Tall R and deep S in mid precordial leads measuring >60 mm 2. LVH + RAD or Clockwise loop 3. RVH + LAD 4. Independent RVH and LVH

How to diagnose LAE in Pediatric ECG

1. >120 ms 2. In bifid P - interpeak distance > 40 ms 3. V1 p > 1 mm depth and width(MORRIS criteria) 4. P axis < -30 5. MACRUZ index- P duration/ PR segment >1.6

RAE Diagnosis

P axis > 60; > 3mm p in Ld II;P initial force in V1 > 1.5mm

Modified Lyon Sokolow criteria in Pediatrics

R in V5/6 plus Sin V1. >45mm (Adult-35) R inV5/6> 35mm( Adult-25-?) R in aVL, aVF> 20 mm (Adult-11 in aVL)

LVH of volume overload criteria

1. Prominent Q in I, aVL., V5-6 2. Tall R in V5-6 3. Upright symmetrical tall T in V5-6

LVH of pressure overload criteria

1. No significant q in 1,aVL, V5-6 2. Slurred upstroke of R in left precordial leads 3. Lvh with strain pattern in V5-6---asymmetric T inversion with ST sagging

How to diagnose RVH in pediatric ECG

1. Upright T in V3R,V1 after day 3 2. R inaVR more than 5 3. RAD > 110 4. R in V1 > 7 mmin child above 6 yrs 5. R in V1 + S in V6 > 11 mm 6. qR in V3R or V 1 7.R/S more than. :::5 if less than 6 month ::3 if 6 months- 3 yrs ::1.5 3-6yrs More than 1 after 6 yrs

Average heart rate in children peaks by

2nd month and then decreases

Max heart rate in neonate

230( starts at 120!)

Avg heart rate at5 yrs

100

Average resting heart rate at 1 year

120

Heart rate reaches adult values by

15 yrs

QRS axis becomes normal by -----age

1 yr

Common causes of left axis deviation at birth

TA and AV canal defect Also causes counterclockwise loop with q in I aVL

In neonates PR intervals can be as short as

80 ms

Difference in preterm (28 wks) ECG from term

Chest leads may show LV dominance with normal or left ward QRS axis.

How to quickly spot an abnormal axis

If lead I or II is negative it is usually abnormal

Triclofos ( pedichloryl) dose in children

50 mg/kg ie 1/2 ml/ kg wt

14 lead ECG is routine in child because

More proportion of heart is towards right side. So V3 R and V4 R

What happens to ECG voltage with inspiration and expiration

Inspiration voltage decreases | Expiration voltage increases

In children upper limit of PR interval is taken as

160 ms For a newborn upperlimit is 120 ms(some say 140) Adult-200 ms

Short PR interval in Pediatric is considered as less than

100 ms

Short PR interval in children

DMD, Pompe’s disease As a normal Variant etc

Long PR interval in children, rule out

Myocarditis-Viral, Rheumatic, Lymes disease | Drugs etc

Varying PR interval is seen in

Wandering Atrial Pacemaker Mobitz 1 CHB

Where can you call an S wave rather than a QS

In a lead where q is not expected as in V1- we can call the wave as S wave and not qS

ST elevation in Pediatric ECG consider

Kawasaki, Anomalous coronaries

In adults inverted T wave may be seen upto

V3 (rare)

Tall T wave means-roughly

More than 2/3rd of preceding QRS wave Small T -if less than 1/8 th of preceding QRS Tall T can be a normal variation

T wave amplitude must be checked in

V5,6

Inverted T is normal in

aVR, Ld3

In adults T wave in V1 is

Upright

Physiological T inversion is possible in V5/6 in setting of

1. Trained athletes 2. Fever 3. Anxiety But first rule out pathological causes

T wave alternans is seen in

1. Congenital | 2. Acquired- Pentamidine toxicity

In situs inversus p axis is in

Rt lower quadrant

Isolated levocardia means

Both ventricles and atria are inverted but still heart remains in left side of chest

Pediatric Ecg Flashcards

(73 cards)