Pediatric EKG

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Ventricular rate

  • Younger/smaller --> higher metabolic rate + lower vagal tone --> faster HR
Peds HR.png

Axis

  • Right axis normal in first 6 months of life
    • Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis
  • Extreme superior axis
    • Axis of -90 - 180 degrees
    • Seen with AV canal or atrial septal defects
  • AVF lead vector
    • Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle
    • Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010]
QRS axis.png


Intervals

  • Age dependant norms
  • Smaller muscle mass--> shorter PR
  • QTc longer in infants <6mo
Intervals.png


T-wave inversions

  • T-wave inversions in anterior precordial leads are normal
  • T-waves upright in most leads for first 7 days of life
  • T-waves typically inverted from 7 days to adolescence
  • Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic)


Voltage/Ventricular hypertrophy

  • Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages
    • V2-V5 most likely to appear high voltage
    • EKG auto-interpretations may "over-report" left or right ventricular hypertrophy
  • LVH (quick/dirty method)
    • If R of V6 intersects with baseline of V5--> abnormal
  • RVH indicators
    • Upright T-wave in V1 after 7 days of life
    • If RSR' present; R' taller than R wave
    • Pure R wave in V1 in child >6mo
Voltage RVH-LVH.png


See Also

External Links

References

Authors:

Claire