Pediatric ECGs: Difference between revisions

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Pediatric ECGs (view source)

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A excellent description of the neonatal electrocardiogram has been made by Schwarz et al.<cite>schwarz1</cite><cite>schwarz2</cite>
==Heart Axis==
==Heart Axis==
Normal heart axis values<cite>aha</cite>
{| class="wikitable" font-size="80%" width="100%" style="border:1px solid #E2ACB1;border-spacing:8px;" border="1"
{|Frontal Axis
|+ Normal heart axis values<cite>aha</cite>
!Age
!Age
!QRS Axis Normal Values
!QRS Axis Normal Values
!Abnormal Values
!Abnormal Values
!Description
!Description
 
|-  
|-
|Adult
|Adult
| -30° to 90°  
| -30° to 90°  
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| 90° to 120°
| 90° to 120°
|-
|-
| 90° to 120°
| 90° to 180°
|}
|}
|
|
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Left-axis deviation
Left-axis deviation
|-
|-
|1 to 5 y
|1 year to 5 years
|5° to 100°  
|5° to 100°  
|>100°
|>100°
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|-
|-
|1 mo to 1 y
|1 mo to 1 y
|10° to 120°
| 10° to 120°
|>120°  
|>120°  
<10° to -90°  
<10° to -90°  
Line 68: Line 69:
Left axis deviation
Left axis deviation
|}
|}
==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<cite>aha</cite>
*'''LBBB''': if consistent morphology and QRS width >90ms in children < 4 years and >100ms in children 4-16 years<cite>aha</cite>
==Normal neonatal ECG standards==
{| class="wikitable" font-size="80%" width="100%" style="border:1px solid #E2ACB1;border-spacing:8px;" border="1"
|+Normal neonatal ECG standards<cite>schwarz1</cite>
! style="width:70px" | Age group
! style="width:90px" | Heart rate<br/>(beats . min<sup>-1</sup>)
! style="width:105px" | Frontal plane<br/>QRS axis<sup>a</sup><br/>(degrees)
! style="width:65px"  | P wave<br/>amplitude<br/>(mm)
! style="width:100px" | P-R<br/>interval<sup>a</sup><br/>(s)
! style="width:100px" | QRS<br/>duration<sup>a</sup><br/>V<sub>5</sub>
! style="width:40px"  | Q III<sup>c</sup> (mm)
! style="width:40px"  | QV<sub>6</sub><sup>c</sup> (mm)
! style="width:40px"  | RV<sub>1</sub><sup>b</sup> (mm)
! style="width:40px"  | SV<sub>1</sub><sup>b</sup> (mm)
! style="width:50px"  | R/S V<sub>1</sub><sup>c</sup>
! style="width:40px"  | RV<sub>6</sub><sup>b</sup> (mm)
! style="width:40px"  | SV<sub>6</sub><sup>b</sup> (mm)
! style="width:50px"  | R/S V<sub>6</sub><sup>c</sup>
! style="width:70px"  | SV<sub>1</sub> + RV<sub>6</sub><sup>c</sup> (mm)
! style="width:70px"  | R + SV<sub>4</sub><sup>c</sup> (mm)
|-
|0–1 days
| align="center" | 93–154 (123)
| align="center" | +59 to +192 (135)
| align="center" | 2·8
| align="center" | 0·08–0·16 (0·11)
| align="center" | 0·02–0·08 (0·05)
| align="center" | 5·2
| align="center" | 1·7
| align="center" | 5–26
| align="center" | 0–22·5
| align="center" | 9·8
| align="center" | 0–11
| align="center" | 0–9·8
| align="center" | 10
| align="center" | 28
| align="center" | 52
|-
|1–3 days
| align="center" | 91–159 (123)
| align="center" | +64 to +197 (134)
| align="center" | 2·8
| align="center" | 0·08–0·14 (0·11)
| align="center" | 0·02–0·07 (0·05)
| align="center" | 5·2
| align="center" | 2·1
| align="center" | 5–27
| align="center" | 0–21
| align="center" | 6
| align="center" | 0–12
| align="center" | 0–9·5
| align="center" | 11
| align="center" | 29
| align="center" | 52
|-
|3–7 days
| align="center" | 90–166 (129)
| align="center" | +77 to +187 (132)
| align="center" | 2·9
| align="center" | 0·08–0·14 (0·10)
| align="center" | 0·02–0·07 (0·05)
| align="center" | 4·8
| align="center" | 2·8
| align="center" | 3–24
| align="center" | 0–17
| align="center" | 9·7
| align="center" | 0·5–12
| align="center" | 0–9·8
| align="center" | 10
| align="center" | 25
| align="center" | 48
|-
|7–30 days
| align="center" | 107–182 (149)
| align="center" | +65 to +160 (110)
| align="center" | 3·0
| align="center" | 0·07–0·14 (0·10)
| align="center" | 0·02–0·08 (0·05)
| align="center" | 5·6
| align="center" | 2·8
| align="center" | 3–21·5
| align="center" | 0–11
| align="center" | 7
| align="center" | 2·5–16
| align="center" | 0–9·8
| align="center" | 12
| align="center" | 22
| align="center" | 47
|-
|1–3 months
| align="center" | 121–179 (150)
| align="center" | +31 to +114 (75)
| align="center" | 2·6
| align="center" | 0·07–0·13 (0·10)
| align="center" | 0·02–0·08 (0·05)
| align="center" | 5·4
| align="center" | 2·7
| align="center" | 3–18·5
| align="center" | 0–12·5
| align="center" | 7·4
| align="center" | 5–21
| align="center" | 0–7·2
| align="center" | 12
| align="center" | 29
| align="center" | 53
|-
| colspan="16" |
<ul>
<li><sup>a</sup> 2nd–98th percentile (mean)</li>
<li><sup>b</sup> 2nd–98th percentile (1 mm=100 µV)</li>
<li><sup>c</sup> 98th percentile (1 mm=100 µV)</li>
</ul>
|}
==Distinguishing tachyarrhythmias in infants==
{| class="wikitable" font-size="80%" width="100%" style="border:1px solid #E2ACB1;border-spacing:8px;" border="1"
|+ Distinguishing tachyarrhythmias in infants<cite>schwarz1</cite>
! style="width:80px" | &nbsp;
! style="width:200px" | Sinus tachycardia
! style="width:200px" | SVT
! style="width:200px" | Atrial flutter
! style="width:200px" | VT
|-
| valign="top" | '''History'''
| valign="top" | Sepsis, fever, hypovolaemia, etc.
| valign="top" | Usually otherwise normal
| valign="top" | Most have a normal heart
| valign="top" | Many with abnormal heart
|-
| valign="top" | '''Rate'''
| valign="top" | Almost always <230 b/min
| valign="top" | Most often 260–300 b/min
| valign="top" | Atrial 300–500 b/min. Vent. 1:1 to 4:1 conduction
| valign="top" | 200–500 b/min
|-
| valign="top" | '''R-R interval variation'''
| valign="top" | Over several seconds may get faster and slower
| valign="top" | After first 10–20 beats, extremely regular
| valign="top" | May have variable block (1:1, 2:1, 3:1) giving different ventricular rates
| valign="top" | Slight variation over several beats
|-
| valign="top" | '''P wave axis'''
| valign="top" | Same as sinus almost always visible P waves
| valign="top" | 60% visible P waves, P waves <em>do not</em> look like sinus P waves
| valign="top" | Flutter waves (best seen in LII, LIII, aVF, V<sub>1</sub>)
| valign="top" | May have sinus P waves continuing unrelated to VT (AV dissociation), retrograde P waves, or no visible P waves
|-
| valign="top" | '''QRS'''
| valign="top" | Almost always same as slower sinus rhythm
| valign="top" | After first 10–20 beats, almost always same as sinus
| valign="top" | Usually same as sinus, may have occasional beats different from sinus
| valign="top" | Different from sinus (<em>not</em> necessarily ‘wide’)
|-
| colspan="5" |
<ul>
<li>SVT = Supraventricular tachycardia</li>
<li>VT = ventricular tachycardia</li>
</ul>
|}
==References==
==References==
<biblio>
#aha pmid=19228822
#aha pmid=19228822
#schwarz1 pmid=12269267
#schwarz2 pmid=12739597
</biblio>
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