Download Pediatric ECG

Pediatric ECG
Dr.Emamzadegan
ECG
1.RATE
2.Rhythm
3.Axis
4. RVH,LVH
5. P;QT;ST- T change
ECG
1. NL ECG with age (1866)
2.13 lead (V3R or V4R)
3. T change( T pos … 48 hr ; Abnormal >
1w)
4.Axis in neon = +110 to +180 (RAD)
5.Prominent R in V1,V3R until 8 Y/O.
6. R : S ratio >1 in lead V4R until they are 4yr
ECG
7.The diagnosis of pathologic right
ventricular hypertrophy is difficult in the 1st
wk of life.
8. An adult electrocardiographic pattern
seen in a neonate suggests left ventricular
enlargement.
9. situs inversus: the P wave may be
inverted in lead I.
ECG
10. Inverted P waves in Ieads II and aVF are
seen in nodal or junctional rhythms.
11. Tall (>2.5 mm), narrow, and spiked P
waves : PS; Ebstein;T At.; Cor pulmonale.
12. Broad P waves, commonly bifid and
sometimes biphasic, are indicative of left
atrial enlargement.(VSD;PDA;MS;MR)
ECG
13.Flat P waves = hyperkalemia.
14. RVH : (1) a qR pattern in the right ventricular
surface leads; (2) a positive T wave in leads V3R-V4R and
V1-V3 between the ages of 5 days and 6yr; (3) a monophasic R
wave in V3R, VaR, or V1; (4) an rsR'pattern in the right precordial
leads with the 2nd R wave taller than the initial one; (5) age corrected
increased voltage of the R wave in leads V3R-V4R or
the S wave in leads V6-V7, or both; (5) marked right axis deviation
(>120 degrees in patients beyond the newborn period);
(7) complete reversal of the normal adult precordial RS pattern;
and (8) right atrial enlargement. At least two of these changes
should be present to support a diagnosis of RVH.
ECG
15. Systolic overload (RV) : pure ,tall R in
V1,2
16. Diastolic overload : rSR‘ ; slightly
increased QRS duration.
17. Mild to mod.PS …..rSR‘ in V1,2
ECG
18. LVH :
( 1 ) depression of the ST segments and
inversion of the T waves in the left precordial
leads (V5, V6, and V7), known as a left
ventricular strain pattern-these findings
suggest the presence of a severe lesion;
(2) a deep Q wave in the left precordial
leads;
(3)increased voltage of the S wave in V3R and
V1 or the R wave in V5-V7, or both.
ECG
19. Systolic overload (LV): ST-T change
20. Diastolic overload (LV) : Q,R & NL T
21. complere right bundle branch block :
may be congenital or may be acquired after
surgery for congenital heart disease,
especially when a right ventriculotomy has
been performed, as in repair of the
tetralogy of Fallot.
ECG
22. Congenital left bundle branch block is rare; this pattern
is occasionally seen with Cardiomyopathy.
23. Corrected Q-T interval (Q-Tc): > 0.45 is prolonged
(hpokalemia;hypocalcemia; LQTS)
24. 1st-degree heart block :
congenital,
postoperative,
inflammatory (myocarditis, pericarditis, rheumatic
fever), or pharmacologic (digitalis).
ECG
25. ST elevation:
a.early repolarization;
b.Pericarditis; followed by abnormal T wave
inversion
c. Ischemic injury
ECG
26. ST depression:
myocardial damage or ischemia,
including severe anemia, carbon
monoxide poisoning, aberrant origin of
the left coronary artery from the
pulmonary artery, glycogen storage
disease of the heart, myocardial tumors,
and mucopolysaccharidoses;
cardiomyopathy
ECG
27. T Wave inversion:
myocarditis and pericarditis, or
either right or left ventricular
hypertrophy and strain;
Hypothyroidism may produce flat or
inverted T waves in association with
generalized low voltage.
28. In hyperkalemia, the T waves are
commonly of high voltage and are tentshaped.