Introduction to Pediatric ECGs
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Pediatric EKG: SA Node, Mechanics, and Interpretation, Slides of Pediatrics
An in-depth introduction to pediatric electrocardiograms (ecgs), covering topics such as the sa node, mechanics of tracing, ecg basics, rhythm analysis, and axis determination. It includes information on normal sinus rhythm, p wave axis, rate measurement, and axis determination, as well as abnormalities such as right and left axis deviation and causes of left axis deviation.
Typology: Slides
2012/2013
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Introduction to Pediatric ECGs
Electrophysiology and Anatomy
SA Node
ECG basics: grid paper
Basic electrocardiogram
Rhythm
Sinus rhythm Subsidiary pacemaker Tachyarrhythmia Bradyarrhythmia Atrioventricular block
Normal sinus rhythm
P wave before every QRS QRS following every P wave Normal P wave axis Normal PR interval is NOT required
Rate
Measured in beats per minute 60 / RR interval (in seconds) 300 / number of “big boxes” between consecutive QRS complexes 1500 / number of “little boxes” between consecutive QRS complexes
Heart rate
Known time interval Beats in 6 seconds (30 “big boxes”) x 10 Beats in 3 seconds (15 “big boxes”) x 20
Normal resting heart rates
Newborn: 110 - 150 bpm 2 years: 85 - 125 bpm 4 years: 75 - 115 bpm > 6 years: 60 - 100 bpm Adult: 50 - 100 bpm
Axis
Hexaxial reference system Bipolar limb leads I, II, III Augmented unipolar leads aVR, aVL, aVF Horizontal reference system Precordial leads V1 - V Right sided leads (e.g. rV3)
Axis determination
Successive approximation Locate quadrant with leads I and aVF Narrow down by using leads within quadrant Use most equiphasic lead Axis is perpendicular to that lead, in the quadrant previously identified
Equal amplitudes If two leads with equal net QRS amplitudes exist, the mean axis lies midway between the axis of these two leads
Quadrant determination
Normal axis
Left axis “Boston” Right axis
Extreme R/L axis “Seattle”
Axis determination
Amplitude vector Add net R-S in lead I, R-S in aVF Plot in mm on grid (lead I horizontal, lead aVF vertical) Draw vector from origin to net amplitude Angle of vector = axis
Right axis deviation
Axis > 100 degrees “Normal for age”: rightward axis > 100 degrees, but within normal limits for age (e.g. 2 week old with axis of +140) Suggestive of RVH