DR KIRAN VS NARAYANA HRUDAYALAYA BANGALORE PEDIATRIC ECG IS SIMPLE!
Jun 26, 2015
DR KIRAN VS
NARAYANA HRUDAYALAYA
BANGALORE
PEDIATRIC ECG IS SIMPLE!
WHY ME?
Conduction systemLeads and wavesHow to report?Why ECG alone is useless?How to diagnose with help of ECG?How to evaluate arrhythmias?Answer to win!Conclusion!!
WHAT IS THERE?
CHEST LEADS PLACEMENT
NORMAL ECG
Standardization: 10 mm high so that 10 mm = 1 mV.
Paper speed is correct.Heart rate: 1500/SMALL squaresIntervals: PR and QT intervals, width of the
QRS complexes.QRS axis: L1 and aVF
BASIC BEGINNING
How to analyse?P: there or not? RatePP: Regular or not?PR: normal or short?QRS: Follows P? RateQRS: narrow or wide?RR: Regular or not?ST: Normal or not?QT: Normal or long?Put them together
Normal Sinus Rhythm
HOW TO REPORT ECG: WRITE AND PRACTICE!!
AXIS DETERMINATION
INSTANT AXIS!
ATRIAL ENLARGEMENT
NEVER diagnose only on ECG!ECG
Clinical data
ECG
Diagnosis Prize!!
QUIZ WITH PRIZES!
RATE, RHYTHM, AXIS, FORCES
4-mo old boyCyanotic, SO2 80%No spellsESM LUSBYour diagnosis:
CLINICAL DATA
ANSWER?
Sinus tachycardia, LAD, LV forces: TRICUSPID ATRESIA
INTERPRET THE ECG: NO DIAGNOSIS!
14-year old girlAsymptomatic nowIntermittent palpitations, no syncopeSO2: 94%Split S2, multiple heart sounds, no murmursDiagnosis?
CLINICAL DATA
ANSWER?
Sinus, Tall P, splintered QRS: Ebstein anomaly
READ THE ECG
6-year old boyAsymptomaticSO2: 98%RV apexNo clickS2 spilt not well appreciatedESM LUSBYour diagnosis in light of ECG?
CLINICAL DATA
DIAGNOSIS?
Sinus, RAD, RV Forces: SEVERE PULMONIC STENOSIS
READ THE ECG
7-day old girlTachypneoa with recessionsSO2 88% Split S2ESM LUSBYour diagnosis
CLINICAL DATA
YOUR DIAGNOSIS?
Sinus tachycardia, RAD, rsR’ in V1, V2, RV forces: TAPVC
INTERPRET THE ECG: NO DIAGNOSIS
1-year oldCyanoticSO2: 78%ClubbingS2 singleESM LUSBYour diagnosis
CLINICAL DATA
YOUR DIAGNOSIS
Sinus, RAD, RV forces, Early transition: TOF
INTERPRET THE ECG (CAN NEGLECT THE POINTERS)
3-month oldSevere LV dysfunctionPulmonary venous congestionCTR 70%LV EF 15%Your diagnosis?
CLINICAL DATA
YOUR DIAGNOSIS? (CAN CONSIDER POINTERS!)
Sinus, LAD, Deep Q in lat leads, ST down: ALCAPA
READ ONLY THE ECG
3-year old boyFailure to thriveDOES2 splitPSM at apexESM LUSBYour diagnosis?
CLINICAL DATA
YOUR DIAGNOSIS?
Sinus tachycrdia, LAD, Long PR, rsR’ in V1, V2, BV Forces: Primum defect with MR
ONLY THE ECG FINDINGS
NewbornSevere cyanosisLV apexS2 singleNo precordial murmurContinuous murmur at LUSBYour diagnosis
CLINICAL DATA
YOUR DIAGNOSIS?
Sinus tachycardia, RAD, RAE, BV forces: pulmonary atresia with intact IVS, ASD
ONLY THE ECG FINDINGS
1-day old boyTachypneoaFeeble pulsesNo R-F delayFeatures of shockRV apexYour diagnosis
CLINICAL DATA
YOUR DIAGNOSIS
Sinus tachycardia, RAD, RAE, RV forces, poor R progression: HLHS
ONLY ECG FINDINGS
18-year old boyExertional breathlessnessBaseline SO2: 88%, drops to 80% with
minimal effortRV apexLoud S2Your diagnosis
CLINICAL DATA
YOUR DIAGNOSIS
Sinus tachycardia, Sup axis, RAE, RV forces with strain: Eisenmengerization
ONLY ECG FINDINGS
8-year old girlHad cardiac surgeryAdditional procedure after 3 weeksAsymptomatic nowYour diagnosis?
CLINICAL DATA
YOUR DIAGNOSIS
AV dissociation, Sharp artefacts before each QRS, Sup axis, LBBB pattern: VVI Pacemaker with lead in RV
QTc INTERVAL & LQTS
Are there normal P waves present?Are the QRS complexes wide or narrow?What is the relationship between the P waves
and QRS complexes?Is the rhythm regular or irregular?
4Qs OF RHYTHM
ECG per-se is uselessAlways with clinical scenario“Treat the pt; not the ECG” is clichéTreat pt till ECG is OK!Get a good 12-lead ECG with Rhythm strip for
atleast 15 secondsGood luck with ECGs
REMEMBER
Arrhythmia ECGs need analysis “It looks like....?!” : rarely correctMore it looks normal, more it is likely to be
normal!Analysis of arrhythmia is more important than
giving it a named diagnosisNormal ECG is the most important one to learnTRY, PRACTICE, FAIL, RELEARN – ITS GOOD!!
That’s it!!
Hell is empty and all the devils are here. -- Wm. Shakespeare, "The Tempest"