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Cardio > Pediatric Ecg > Flashcards

Pediatric Ecg Flashcards

1
Q

Heart rate from rhythm strip

A

Multiply with 6. One paper is 10 sec

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

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2
Q

1mm in ECG is……..SECONDS

A

0.04. SECONDS

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3
Q

Prolonged PR interval in Ped ecg

A

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

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4
Q

Short PR interval in Ped ecg

A

Glycogen storage disease

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5
Q

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

A

One month

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6
Q

Highly specific for RVH in Pediatric ECG

A

qR in V1

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7
Q

Abnormal Q waves in V5 and V6 in Ped ecg indicate

A

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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8
Q

Inverted T waves in I and aVL in Ped ecg indicate

A

LV strain pattern

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9
Q

ECG finding in biventricular hypertrophy in V2-5

A

Large equiphasic QRS . Also in 2 or more limb leads

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10
Q

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

A

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

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11
Q

ST segment is judged in relation to ——

A

TP segment

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12
Q

T wave finding in first week of life

A

Upright in all precordial leads

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13
Q

T wave change after first week of life

A

T inversion in V1-3

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14
Q

Tall peaked T waves indicates

A

Volume overload
Early depolarization
Hyperkalemia

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15
Q

Large deep inverted T and Neuro

A

Raised intracranial pressure

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16
Q

Hypothyroidism and T wave change

A

Flat T waves

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17
Q

U waves seen in

A

Hypokalemia

Sinus Brady

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18
Q

Most common type of SVT in children

A

AVRT:

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

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19
Q

Sinus arrhythmias defined as RR Interval variation more than

A

120 ms or 3 small spaces

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20
Q

In situs solitus P wave is always positive in

A

I,II,V4-6

Negative in aVR

Variable in others- Almost always upright in aVF

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21
Q

Normal P wave axis

A

30-60

More than 75 is abnormal

More than 90 indicates Situs inversus

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22
Q

Normally the widest P wave can be upto

A

100 ms

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

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23
Q

Normal PR in a child

A

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

Adult-120-200ms

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24
Q

QRS duration is traditionally measured in

A

Limb leads or V1-2

> 100 ms may be abnormal

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25
Q

Low voltage QRS means

A

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

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26
Q

High voltage limb leads

A

> 20mm in limb leads and >30 mm in precordial leads.

High voltage complexes may be normal

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27
Q

Small q is normally seen in pediatric ecg in

A

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

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28
Q

Early transition of QRS

A

If it occurs in V2

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29
Q

Late transition of QRS

A

If it happens in V5

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30
Q

Normal QRS axis in children

A

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

Zulfikar

31
Q

Clockwise loop in pediatric ecg

A

Q in 2,3,aVF

Counter in 1,aVL

Anti’s are kept little laterally

32
Q

RUQ axis and loop

A

RUQ Axis + clockwise loop=extreme RAD;

If counter clockwise loop= extreme LAD

33
Q

ST elevation which may be normally seen in young

A

<1mm in V1-3

34
Q

Maximum height of normal T

A

Upto 6 mm in limb leads

Upto 10 mm in precordial leads

35
Q

T wave in pediatric popl- normal pattern

A

T UPRIGHT upto 3 days–V3R,V1,V2

From 4th day —T is INVERTED upto V3

Older children V3 T is usually upright

36
Q

U wave amplitude

A

Usually 1/4 of T wave and is positive

Repolarisation of His Purkinje system

37
Q

VT in children

A

Uncommon in children. Can occur in Long QT syndrome

38
Q

How to diagnose Biventricular hypertrophy in children

A
  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
39
Q

How to diagnose LAE in Pediatric ECG

A
  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
40
Q

RAE Diagnosis

A

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

41
Q

Modified Lyon Sokolow criteria in Pediatrics

A

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)

42
Q

LVH of volume overload criteria

A
  1. Prominent Q in I, aVL., V5-6
  2. Tall R in V5-6
  3. Upright symmetrical tall T in V5-6
43
Q

LVH of pressure overload criteria

A
  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
44
Q

How to diagnose RVH in pediatric ECG

A
  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
45
Q

Average heart rate in children peaks by

A

2nd month and then decreases

46
Q

Max heart rate in neonate

A

230( starts at 120!)

47
Q

Avg heart rate at5 yrs

A

100

48
Q

Average resting heart rate at 1 year

A

120

49
Q

Heart rate reaches adult values by

A

15 yrs

50
Q

QRS axis becomes normal by —–age

A

1 yr

51
Q

Common causes of left axis deviation at birth

A

TA and AV canal defect

Also causes counterclockwise loop with q in I aVL

52
Q

In neonates PR intervals can be as short as

A

80 ms

53
Q

Difference in preterm (28 wks) ECG from term

A

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

54
Q

How to quickly spot an abnormal axis

A

If lead I or II is negative it is usually abnormal

55
Q

Triclofos ( pedichloryl) dose in children

A

50 mg/kg

ie 1/2 ml/ kg wt

56
Q

14 lead ECG is routine in child because

A

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

57
Q

What happens to ECG voltage with inspiration and expiration

A

Inspiration voltage decreases

Expiration voltage increases

58
Q

In children upper limit of PR interval is taken as

A

160 ms

For a newborn upperlimit is 120 ms(some say 140)

Adult-200 ms

59
Q

Short PR interval in Pediatric is considered as less than

A

100 ms

60
Q

Short PR interval in children

A

DMD,
Pompe’s disease
As a normal Variant etc

61
Q

Long PR interval in children, rule out

A

Myocarditis-Viral, Rheumatic, Lymes disease

Drugs etc

62
Q

Varying PR interval is seen in

A

Wandering Atrial Pacemaker
Mobitz 1
CHB

63
Q

Where can you call an S wave rather than a QS

A

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

64
Q

ST elevation in Pediatric ECG consider

A

Kawasaki, Anomalous coronaries

65
Q

In adults inverted T wave may be seen upto

A

V3 (rare)

66
Q

Tall T wave means-roughly

A

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

67
Q

T wave amplitude must be checked in

A

V5,6

68
Q

Inverted T is normal in

A

aVR, Ld3

69
Q

In adults T wave in V1 is

A

Upright

70
Q

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

A
  1. Trained athletes
  2. Fever
  3. Anxiety

But first rule out pathological causes

71
Q

T wave alternans is seen in

A
  1. Congenital

2. Acquired- Pentamidine toxicity

72
Q

In situs inversus p axis is in

A

Rt lower quadrant

73
Q

Isolated levocardia means

A

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

Cardio (36 decks)

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