Paediatric ECG

Question 1

What axis deviation is normal in children?

Answer 1

right axis deviation

Question 2

What T wave changes are normal in children?

Answer 2

T wave inversions in V1-3 (‘Juvenile T wave pattern’)

Question 3

Why is there initial right ventricular dominance in a neonate? (and therefore right axis deviation on ECG)

Answer 3

In utero, blood is shunted away from the pulmonary vasculature leading to higher pulmonary pressures and a relatively larger and thicker right ventricle. Right axis deviation is thus a normal finding at birth, and usually resolves by 6 months of age.

Question 4

How do you work out the axis on a paediatric ECG?

Answer 4

isoelectric method
axis is at 90 degrees to the isoelectric lead

find the most isoelectric lead out of 1,2,3,AVR,AVL,AVF (isoelectric = QRS as much above line as below line)

find the most positive lead (tallest R wave)

use the chart with the axis on and go 90 degrees from the most isoelectric lead towards the most positive lead
it will land in an area that is the axis deviation