pedekg - IntroductiontoPediatricECGs Thomas R. Burklow, MD...

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Pediatric ECGs Introduction to Pediatric ECGs Thomas R. Burklow, MD Asst C, Pediatric Cardiology Walter Reed Army Medical Center
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Pediatric ECGs Electrophysiology and Anatomy SA Node
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Pediatric ECGs Mechanics of tracing Small box = 1 x 1 mm Large box = 5 x 5 mm Paper speed (horizontal boxes) Standard = 25 mm/sec Voltage calibration (vertical boxes) Standard = 10 mm/mV (2 big boxes) Half standard = 5 mm/mV (1 big box) May have 10/5: standard for chest leads, half-standard for precordial leads NOTE THE CALIBRATION!!
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Pediatric ECGs ECG basics: grid paper
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Pediatric ECGs Basic electrocardiogram
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Pediatric ECGs Interpretation Be systematic!! Rhythm Rate Axis Intervals Atrial enlargement Ventricular hypertrophy ST/T wave evaluation
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Pediatric ECGs Rhythm Sinus rhythm Subsidiary pacemaker Tachyarrhythmia Bradyarrhythmia Atrioventricular block
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Pediatric ECGs Normal sinus rhythm P wave before every QRS QRS following every P wave Normal P wave axis Normal PR interval is NOT required
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Pediatric ECGs P wave axis Atrial depolarization occurs from SA node Wave passes right to left, top to bottom Positive deflections in leads I (right to left) and aVF (top to bottom) Normal P wave axis = 0-90 degrees Abnormal axis implies ectopic pacemaker Coronary sinus or “low right atrial” rhythm is common benign finding, especially in teens Positive in lead I, negative in aVF
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Pediatric ECGs 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
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Pediatric ECGs Heart rate Known time interval Beats in 6 seconds (30 “big boxes”) x 10 Beats in 3 seconds (15 “big boxes”) x 20
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Pediatric ECGs Heart rate Rate approximation Rate estimate: 300 - 150 - 75 - 60 - 50 Easy to memorize No calculator needed
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Pediatric ECGs 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
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Pediatric ECGs Axis Hexaxial reference system
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pedekg - IntroductiontoPediatricECGs Thomas R. Burklow, MD...

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