11
Paediatric ECGCONTENTS
1.ECG2.Use of Paediatric ECGs3.Indications4.ECG recording in
children5.Electrophysiology and anatomy6.Reference System7.Mechanic
of tracing8.Basic measurement9.Normal ECGs10.Normal values and
interpretation11.Common deviations from normal ECGs in children
Standard ECG12 leads ECG 2. Use of Paediatric ECGs1.To be aware
of age related differences in ECG indications2.To know normal
ranges for ECG variables 3. Indications for a Paediatric
ECGSyncope/seizure Exertional symptoms Drug ingestions
Tachyarrhythmia Bradyarrhythmia Cyanotic episodes Syncope/seizure
Exertional symptoms Drug ingestions Tachyarrhythmia Bradyarrhythmia
Cyanotic episodes Heart Failure Hypothermia Heart Failure
Hypothermia Mnemonic form - PAEDS ECG + 2 Fs P pericarditis (or
myocarditis), post cardiac surgeryA arrhythmias (tachy or
bradyarrhythmia) E exertional symptoms D drugs, disease (Kawasaki)
S syncope/seizure E electrolyte disturbance C cyanosis, contusion
(myocardial), cold (hypothermia)G congenital heart defects 2 Fs:
Fever (rheumatic) Failure (heart) 4. ECG recording in
childrenDistract child Limb electrodes proximal, less movement
artifactStandard adult positions, but add V3R or V4R to detect
right ventricular or atrial hypertrophy
5. Electrophysiology and anatomy
12-lead ECG provides spatial information about the heart's
electrical activity in 3 approximately orthogonal directions.Right
to LeftSuperior to InferiorAnterior to Posterior
7. Mechanic of tracingSmall box = 1 x 1 mmLarge box = 5 x 5
mmECG 1
8. Basic measurementPaper speed (horizontal boxes)Standard = 25
mm/sec
9.Normal ECGs
P wavethe sequentialactivation (depolarization) of the right and
left atriaQRS complexright and left ventricular depolarization
(normally the ventricles are activated simultaneously)ST-T
waveventricular repolarizationPR intervaltime interval from onset
of atrial depolarization (P wave) to onset of ventricular
depolarization (QRS complex)QRS durationduration of ventricular
muscle depolarizationQT intervalduration of ventricular
depolarization and repolarizationRR interval: duration of
ventricular cardiac cycle (an indicator of ventricular rate)PP
intervalduration of atrial cycle (an indicator of atrial rate)10.
Normal values and interpretation
RateRhythmAxisIntervalsAtrial enlargementVentricular
hypertrophyST/T wave evaluationDetermination of amplitudeAmplitude
of ECG deflections are important for interpretation.Calibration
gives the standardization of an ECG.
A - means 1 mV=10mmB - means limb leads are in full
standardization but precordial leads are half standardized.C -
means both precordial leads and limb are in half standardization.D
- means limb leads are in half standardization but precordial leads
are in 1/4 standardisation.E and F - show using two times the full
standardization.
ECG 2
RateMeasured in beats per minuteMeasuring RR interval directly
1. 60 / RR interval (in seconds)2. 300 / number of big boxes
between consecutive QRS complexes3. 1500 / number of little boxes
between consecutive QRS complexes
ECG 3
RR intervalHow many seconds?9x0.04 = 0.36 sec 60 / 0.36 = 167
bpm How many big boxes between R and R?1.8 big boxes300 / 1.8 = 167
bpmHow many small boxes between R and R?9 small boxes1500/9 = 167
bpm
Count the heart rate.ECG 4
In cases with irregular rhythm
To count the number of beats in 6 second (30 big boxes)To
multiply by 10ECG 5
Rhythm
Sinus rhythmTachyarrhythmiaBradyarrhythmiaAtrioventricular
block
Axis
QRS deflectionAxis
Lead 1aVF
PositivePositiveNormal
PositiveNegativeLAD
NegativePositiveRAD
NegativeNegativeExtreme RAD or LAD
ECG 6
ECG 7
ECG 8