Pediatric EKG

Pediatric EKG

• Arrhythmias • CHD • Ischemia/Infarction • Miscellaneous (Drug, Electrolyte Abnormalities, …)

Pediatric EKG

• Screening • Diagnosis • Follow up

EKG Leads

Normal Values (Davignon)

P wave

• Atrial Depolarization • Lead II • Duration (≤3y max=0.09s, >3y max=0.1s) • Amplitude (max=2.5mm) • Lead V1 • Axis • Arrhythmias

P wave

QRS Complex

• Ventricular Depolarization • Duration (V5) • Amplitude (high, low if R+S ≤ 5mm for limb leads & ≤ 10mm for precordial leads) • Axis • Morphology (QRSR’)

T Wave

• Ventricular repolarization • Amplitude ( high if ≥ 7mm in limb leads & ≥ 10mm in precordial leads ) • Axis

• I,II • aVf • aVr • V3r, V1 • V6

T Wave Axis

positive after 48 hours positive after 5 days negative negative (6 days to 6 years) positive

T Wave

P Wave Axis Abnormalities

P Wave Axis Abnormalities

RVH

• qR (V1) • Pure R (V1) • T wave abnormalities (V1) • R(V1) > P98 • S(V6) > P98 • R/S(V1) > P98 • RSR’(V1) • RAD (after 3 years of age)

RVH

qR

RVH

Pure R

RVH

Progressive T wave abnormalities

RVH

RSR’ <1year at least 15mm >1 year at least 10mm Normal QRS duration

LVH

• ST segment & T wave abnormalities (I, II, aVf, V5, V6) • R(V6) > P98 • S(V1) > P98 • R(V6)+S(V1) > P98 • Deep q (V6) (> 4mm) • LAD

LVH

LVH

BVH

• Criteria for both RVH & LVH • RVH & normal forces of LV • LVH & normal forces of RV • R+S (mid-precordial leads) (Katz-Wachtel Index)

* * *

BVH

Atrial Enlargement • Lead II (2.5×2.5) • Lead V1 (1×1)

RAE

• Tall P wave • Large initial deflection (V1)

LAE

• Broad P wave • Large terminal deflection (V1)

LAE

BAE

• Both Criteria

The End