CHD ECG

Question 1

Secundum atrial septal defect

Answer 1

Rhythm: normal sinus rhythm, increased risk of AF with age

PR interval: first degree AV block in 6-19%

QRS axis: 0° to 180°; RAD; LAD in Holt-Oram or LAHB

QRS Configuration: rSr´ or rsR´ with RBBBi>RBBBc

Atrial Enlargement: RAE 35%

Ventricular hypertrophy: Uncommon

Particularities: “Crochetage” pattern

Question 2

Ventricular Septal Defect

Answer 2

Rhythm: normal sinus rhythm, PVCs

PR interval: Normal or mild ↑; 1° AVB 10%

QRS axis: RAD with BVH; LAD 3% to 15%

QRS Configuration: Normal or rsr´; possible RBBB

Atrial Enlargement: Possible RAE±LAE

Ventricular hypertrophy: BVH 23% to 61%; RVH with Eisenmenger

Particularities: Katz-Wachtel phenomenon

Question 3

AV canal defect

Answer 3

Rhythm: normal sinus rhythm, PVCs 30%

PR interval: 1° AVB >50%

QRS axis: Moderate to extreme LAD; normal with atypical

QRS Configuration: rSr´ or rsR´

Atrial Enlargement: Possible LAE

Ventricular hypertrophy: Uncommon in partial; BVH in complete; RVH with Eisenmenger

Particularities: Inferoposteriorly displaced AVN

Question 4

Patent ductus arteriosus

Answer 4

Rhythm: normal sinus rhythm, ↑ IART/AF with age

PR interval: ↑ PR 10% to 20%

QRS axis: Normal

QRS Configuration: Deep S V1, tall R V5and V6

Atrial Enlargement: LAE with moderate PDA

Ventricular hypertrophy: Uncommon

Particularities: Often either clinically silent or Eisenmenger

Question 5

Pulmonary stenosis

Answer 5

Rhythm: normal sinus rhythm

PR interval: Normal

QRS axis: Normal if mild; RAD with moderate/severe

QRS Configuration: Normal; or rSr´; R´ increases with severity

Atrial Enlargement: Possible RAE

Ventricular hypertrophy: RVH; severity correlates with R:S in V1and V6

Particularities: Axis deviation correlates with RVP

Question 6

Aortic coarctation

Answer 6

Rhythm: normal sinus rhythm, possible EAR, SVT; AF/IART 40%

PR interval: 1° AVB common; short if WPW

QRS axis: Normal or LAD

QRS Configuration: Low-amplitude multiphasic atypical RBBB

Atrial Enlargement: RAE with Himalayan P waves

Ventricular hypertrophy: Diminutive RV

Particularities: Accessory pathway common; Q II, III, aVF, and V1–V4

Question 7

Surgically repaired TOF

Answer 7

Rhythm: normal sinus rhythm, PVCs; IART 10%; VT 12%

PR interval: Normal or mild ↑

QRS axis: Normal or RAD; LAD 5% to 10%

QRS Configuration: RBBB 90%

Atrial Enlargement: Peaked P waves; RAE possible

Ventricular hypertrophy: RVH possible if RVOT obstruction or PHT

Particularities: QRS duration±QTd predictive of VT/SCD

Question 8

Congenitally corrected TGA (LTGA)

Answer 8

Rhythm: normal sinus rhythm

PR interval: 1° AVB >50%; AVB 2%/year

QRS axis: LAD

QRS Configuration: Absence septal q; Q in III, aVF, and right precordium

Atrial Enlargement: Not if no associated defects

Ventricular hypertrophy: Not if no associated defects

Particularities: Anterior AVN; positive T precordial; WPW with Ebstein’s

Question 9

Complete TGA/intra-atrial baffle

DTGA with senning procedure

Answer 9

Rhythm: Sinus brady 60%; EAR; junctional; IART 25%

PR interval: Normal

QRS axis: RAD

QRS Configuration: Absence of q, small r, deep S in left precordium

Atrial Enlargement: Possible RAE

Ventricular hypertrophy: RVH; diminutive LV

Particularities: Possible AVB if VSD or TV surgery

Question 10

UVH with Fontan

Answer 10

Rhythm: Sinus brady 15%; EAR; junctional; IART >50%

PR interval: Normal in TA; 1° AVB in DILV

QRS axis: LAD in single RV, TA, single LV with noninverted outlet

QRS Configuration: Variable; ↑R and S amplitudes in limb and precordial leads

Atrial Enlargement: RAE in TA

Ventricular hypertrophy: RVH with single RV; possible LVH with single LV

Particularities: Absent sinus node in LAI; AV block with L-loop or AVCD

Question 11

Dextrocardia / Situs inversus

Answer 11

Rhythm: normal sinus rhythm, P-wave axis 105° to 165° with situs inversus

PR interval: Normal

QRS axis: RAD

QRS Configuration: Inverse depolarization and repolarization

Atrial Enlargement: Not with situs inversus

Ventricular hypertrophy: LVH: tall R V1–V2; RVH: deep Q, small R V1and tall R right lateral

Particularities: Situs solitus: normal P-wave axis and severe CHD

Question 12

ALCAPA

Answer 12

Rhythm: normal sinus rhythm

PR interval: Normal

QRS axis: Possible LAD

QRS Configuration: Ant-lat Q waves; possible ant-sept Q waves

Atrial Enlargement: Possible LAE

Ventricular hypertrophy: Selective hypertrophy of posterobasal LV

Particularities: Possible ischemia

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