Approach to Pediatric ECGs Flashcards
noenates have ___ dominant hearts
right
how many leads in ped ecg?
15 lead configuration
note: in the first week of life. the ecg can be very weird.
- large depolarizations in v2-v3, a complete pausity in V6.
- strange T wave inversions
- just call an expert for help to read the ECG
how should rate and rhythm present in peds?
should be the same as adults. sinus. PR interval and QRS is 1;1
BUT- sinus arrythmia is a common factor in child – just because of their respiration
how do P waves differ in peds vs adults
still positive in lead I because the signal is travelling right to left, but it may be inverte din inferior leads likd II, III and avVF
heart block is common in kids. what is the wenkeback beat?
a SECOND DEGREE heart block where there is a LONG PR interval, a dropped beat, and then a shorter PR interval
T/f wenkeback is normal
true. first and second degree type I blocks are normal in kids.
recall that second dgree heart blocks are those that result in a dropped beat at somepoint
how does axis differ in kids?
there is a little bit of right axis deviation.
comment on axis
negative lead 1, positive avF = right axis deviation
- right axis deviation is normal in kids
note; the QRS complexes in neonates are pretty slim, so it’s easy to miss tachycardias
how do QT intervals differ in peds?
✤ QT interval is dependant on age, heart rate, gender, ethnicity
✤ Boys and pre-pubertal females < 450 msec
✤ Post-pubertal females < 470 msec
- bit faster than adults
R wave progression
when the R wave gets larger and larger from V1-V6. The leads get closer to the left ventricle
- NO r WAVE PROGRESSION IN BABIES
RSR’ presence in neonates– normal or abnormal?
normal as long as there are no abrnomal/DEEP (larger than 0.05ms) Q waves that go along with it. - if there are RSR’ plus Q waves, it can indicate RBBB
How do T waves change in children to adulthood
1 week; T awves can go any which way
- 1 week to 8 years : twave upright in V6, and inverted in V1. can change in the other precordial leads
- 8 + : all become upright (except Avr)
circled finding
U wave. they are just little bumps after the T wave usually in older children or adolescents. normal findings.
- they are abnormal if they are huge (exceeding more than half the t wave)
how do ST segments change in peds?
J point elevation and ST elevation is normal if they are upsloping convex looking. looks like pericarditis, but this phenomenon changes with exercise– the ST elevation goes back down if the heart rate rises.
- if they are dome shaped, its more concerning
