Pediatric ECGs
From ECGpedia
A excellent description of the neonatal electrocardiogram has been made by Schwarz et al.[1][2]
Contents |
[edit] Heart Axis
| Age | QRS Axis Normal Values | Abnormal Values | Description | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Adult | -30° to 90° |
|
| ||||||||||
| 8 to 16 years | 0° to 120° | >120° | Right-axis deviation | ||||||||||
| 5 to 8 years | 0° to 140° | >140°
<0° | Right-axis deviation
Left-axis deviation | ||||||||||
| 1 year to 5 years | 5° to 100° | >100° | Right-axis deviation | ||||||||||
| 1 mo to 1 y | 10° to 120° | >120°
<10° to -90° | Right-axis deviation
Left-axis deviation | ||||||||||
| Neonate | 30° to 90° | >190° to -90°
<30° to <-90° | Extreme right axis deviation
Left axis deviation |
[edit] Conduction: definition of LBBB and RBBB in children
- RBBB: if consistent morphology and if QRS width >90ms in children < 4 years and >100ms in children 4-16 years[3]
- LBBB: if consistent morphology and QRS width >90ms in children < 4 years and >100ms in children 4-16 years[3]
[edit] Normal neonatal ECG standards
| Age group | Heart rate (beats . min-1) | Frontal plane QRS axisa (degrees) | P wave amplitude (mm) | P-R intervala (s) | QRS durationa V5 | Q IIIc (mm) | QV6c (mm) | RV1b (mm) | SV1b (mm) | R/S V1c | RV6b (mm) | SV6b (mm) | R/S V6c | SV1 + RV6c (mm) | R + SV4c (mm) |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0–1 days | 93–154 (123) | +59 to +192 (135) | 2·8 | 0·08–0·16 (0·11) | 0·02–0·08 (0·05) | 5·2 | 1·7 | 5–26 | 0–22·5 | 9·8 | 0–11 | 0–9·8 | 10 | 28 | 52 |
| 1–3 days | 91–159 (123) | +64 to +197 (134) | 2·8 | 0·08–0·14 (0·11) | 0·02–0·07 (0·05) | 5·2 | 2·1 | 5–27 | 0–21 | 6 | 0–12 | 0–9·5 | 11 | 29 | 52 |
| 3–7 days | 90–166 (129) | +77 to +187 (132) | 2·9 | 0·08–0·14 (0·10) | 0·02–0·07 (0·05) | 4·8 | 2·8 | 3–24 | 0–17 | 9·7 | 0·5–12 | 0–9·8 | 10 | 25 | 48 |
| 7–30 days | 107–182 (149) | +65 to +160 (110) | 3·0 | 0·07–0·14 (0·10) | 0·02–0·08 (0·05) | 5·6 | 2·8 | 3–21·5 | 0–11 | 7 | 2·5–16 | 0–9·8 | 12 | 22 | 47 |
| 1–3 months | 121–179 (150) | +31 to +114 (75) | 2·6 | 0·07–0·13 (0·10) | 0·02–0·08 (0·05) | 5·4 | 2·7 | 3–18·5 | 0–12·5 | 7·4 | 5–21 | 0–7·2 | 12 | 29 | 53 |
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[edit] Distinguishing tachyarrhythmias in infants
| Sinus tachycardia | SVT | Atrial flutter | VT | |
|---|---|---|---|---|
| History | Sepsis, fever, hypovolaemia, etc. | Usually otherwise normal | Most have a normal heart | Many with abnormal heart |
| Rate | Almost always <230 b/min | Most often 260–300 b/min | Atrial 300–500 b/min. Vent. 1:1 to 4:1 conduction | 200–500 b/min |
| R-R interval variation | Over several seconds may get faster and slower | After first 10–20 beats, extremely regular | May have variable block (1:1, 2:1, 3:1) giving different ventricular rates | Slight variation over several beats |
| P wave axis | Same as sinus almost always visible P waves | 60% visible P waves, P waves do not look like sinus P waves | Flutter waves (best seen in LII, LIII, aVF, V1) | May have sinus P waves continuing unrelated to VT (AV dissociation), retrograde P waves, or no visible P waves |
| QRS | Almost always same as slower sinus rhythm | After first 10–20 beats, almost always same as sinus | Usually same as sinus, may have occasional beats different from sinus | Different from sinus (not necessarily ‘wide’) |
| ||||
[edit] References
- Schwartz PJ, Garson A Jr, Paul T, Stramba-Badiale M, Vetter VL, and Wren C. Guidelines for the interpretation of the neonatal electrocardiogram. A task force of the European Society of Cardiology. Eur Heart J 2002 Sep; 23(17) 1329-44. pmid:12269267.
- Schwartz PJ, Paul AG Jr, Stramba-Badiale M, Vetter VL, Villain E, and Wren C. Report from the Task Force of the European Society of Cardiology for the interpretation of the neonatal electrocardiogram. Cardiol Young 2002 Dec; 12(6) 592-608. pmid:12739597.
- Surawicz B, Childers R, Deal BJ, Gettes LS, Bailey JJ, Gorgels A, Hancock EW, Josephson M, Kligfield P, Kors JA, Macfarlane P, Mason JW, Mirvis DM, Okin P, Pahlm O, Rautaharju PM, van Herpen G, Wagner GS, and Wellens H. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram: part III: intraventricular conduction disturbances: a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society: endorsed by the International Society for Computerized Electrocardiology. Circulation 2009 Mar 17; 119(10) e235-40. doi:10.1161/CIRCULATIONAHA.108.191095 pmid:19228822.
