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    EKG Pediatrik

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    Chris
    1. This document outlines the routine sequence for interpreting a paediatric ECG, including assessing rhythm, heart rate, QRS axis, intervals, P wave, QRS, ST segment, and T wave. 2. It provides guidelines for normal values of intervals, amplitudes, and durations across different age groups as well as criteria for determining right ventricular hypertrophy, left ventricular hypertrophy, and combined biventricular hypertrophy. 3. Electrolyte abnormalities like hypokalaemia, hyperkalaemia, hypocalcaemia, and hypercalcaemia can also affect the ECG by changing the shape and duration of waves.

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    EKG Pediatrik

    Uploaded by

    Chris
    47 views3 pages
    1. This document outlines the routine sequence for interpreting a paediatric ECG, including assessing rhythm, heart rate, QRS axis, intervals, P wave, QRS, ST segment, and T wave. 2. It provides guidelines for normal values of intervals, amplitudes, and durations across different age groups as well as criteria for determining right ventricular hypertrophy, left ventricular hypertrophy, and combined biventricular hypertrophy. 3. Electrolyte abnormalities like hypokalaemia, hyperkalaemia, hypocalcaemia, and hypercalcaemia can also affect the ECG by changing the shape and duration of waves.

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    Ekg cardiologi kardiologi pediatri

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    1. This document outlines the routine sequence for interpreting a paediatric ECG, including assessing rhythm, heart rate, QRS axis, intervals, P wave, QRS, ST segment, and T wave. 2. It provides guidelines for normal values of intervals, amplitudes, and durations across different age groups as well as criteria for determining right ventricular hypertrophy, left ventricular hypertrophy, and combined biventricular hypertrophy. 3. Electrolyte abnormalities like hypokalaemia, hyperkalaemia, hypocalcaemia, and hypercalcaemia can also affect the ECG by changing the shape and duration of waves.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    47 views3 pages

    EKG Pediatrik

    Uploaded by

    Chris
    1. This document outlines the routine sequence for interpreting a paediatric ECG, including assessing rhythm, heart rate, QRS axis, intervals, P wave, QRS, ST segment, and T wave. 2. It provides guidelines for normal values of intervals, amplitudes, and durations across different age groups as well as criteria for determining right ventricular hypertrophy, left ventricular hypertrophy, and combined biventricular hypertrophy. 3. Electrolyte abnormalities like hypokalaemia, hyperkalaemia, hypocalcaemia, and hypercalcaemia can also affect the ECG by changing the shape and duration of waves.

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    PAEDIATRIC ECG INTERPRETATION

    Routine interpretation: Suggested sequence


    1. Rhythm (sinus or non sinus) by considering the P axis
    2. Heart rate (atrial and ventricular rates, if different)
    3. The QRS axis
    4. Intervals: PR, QRS and QT
    5. The P wave amplitude and duration
    6. The QRS amplitude and R/S ratio, also abnormal Q waves
    7. ST segment and T wave abnormalities

    Rhythm:
    Sinus rhythm is characterized by
    • P waves preceding each QRS complex
    • Normal P axis (0 to +90 degrees) i.e. upright P in I and aVF

    Heart rate:
    At usual paper speed of 25mm/sec, 1mm = 0.04s, 5mm = 0.2s
    Methods used to calculate HR include
    • Count the R-R cycle in 6 large divisions (1/50 min) and multiply by 50
    • Count the number of large divisions between the two R waves and divide that into
    300

    When the ventricular and atrial rates are different, the atrial rate can be calculated using the
    P-P interval

    QRS Axis:
    RV dominance in infants gradually changes to LV dominance in adults
    Hence, there is right axis deviation of QRS till 1 month, adult axis by 3 yr

    Mean and ranges of Normal QRS Axes

    Age Range
    1 wk-1mo +110° (+30 to +180)
    1-3mo +70° (+10 to +125)
    3mo-3yr +60° (+10 to +110)
    Older than 3yr +60° (+20 to +120)
    Adults +50° (-30 to +105)

    Intervals:
    • PR interval varies with age and heart rate

    Age Lower limit Upper limit of norm

    < 3 yr. 0.08sec 0.15 (HR < 100)


    3 - 16 yr. 0.10sec 0.16 (HR < 100)
    > 16 yr. 0.12sec 0.18 (HR < 100)
    QRS duration QT interval

    Prem infants 0.04sec QT measured (sec)


    Full term 0.05sec QTc =
    1 - 3 yr. 0.06sec
    RR interval (sec)
    Child > 3 yr. 0.07sec
    Adult 0.08sec
    According to Bazett’s formula, the
    QTc interval should not exceed
    0.44 sec

    P wave amplitude and duration:


    • Mean P amplitude 1.5mm, max. 3mm.
    • Normal P wave duration 0.06±0.02s.
    • Max. P wave duration <12mo 0.08sec
    Child 0.10sec

    • Right atrial enlargement - P > 3 mm peaked (P pulmonale)

    • Left atrial enlargement - Bifid P > 0.10s (0.08s in infants) (P mitrale)


    P inversion >1mm in V1

    Abnormal Q waves:
    • Q wave commonly present in I, aVL and/or V5 and V6. May also be present in II,
    III and aVF.
    • Presence of Q in V1 = RVH
    • Deep Q waves suggest LVH
    • Average Q wave duration is 0.02s and does not exceed 0.03s

    ST segment and T waves


    • ST segment horizontal, isoelectric shifts may be normal up to
    1mm in limb leads
    2mm in praecordial leads

    • T wave amplitude usually less than the following :


    in V5: < 1yr 11mm > 1yr 14mm
    V6: < 1yr 7mm > 1yr 9mm
    • Tall and peaked in hyperkalaemia

    Criteria for RVH


    • RV1 > 20mm at all ages
    • SV6 > 14mm (0-7days); > 10mm (1wk-6mth); > 7mm (6mth-1yr); > 5mm (>
    1yr)
    • R/S V1 6.5 (0-3mth); 4.0 (3-6mth); 2.4 (6mth-3yr); 1.6 (3-5yr); 0.8 (6-15yr)
    • T wave upright in V4R or V1 after 72 hrs.
    • Presence of Q wave in V1.
    RVH in the newborn
    • S waves in lead I, ≥ 12mm
    • R waves in aVR, ≥ 8mm
    • Important abnormalities in V1 such as:
    o Pure R waves (without S) in V1, ≥ 10mm
    o R waves in V1, ≥ 25mm
    o QR pattern in V1 (also seen in 10% of normal newborns)
    o Upright T waves in V1 in newborns > 3days old
    • QRS axis greater than +180°

    Criteria for LVH


    • SV1 > 20mm
    • RV6 > 20mm > 26mm in older child
    • SV1 + RV6 > 40mm over 1yr of age; > 30mm if < 1yr
    • Q wave of 4mm or more in V 5-6
    • T wave inversion in V 5-6

    Combined biventricular hypertrophy


    • Direct evidence of RVH or LVH
    • R + S in V4 > 70mm

    Diagram illustrating important intervals (or


    durations) and segments of an ECG cycle

    Electrolyte changes affecting ECG

    Hypokalaemia < 2.5 mmol/l Hyperkalaemia > 6 mmol/l


    T Waves low, flat or inverted Tall peaked T
    ST Segment depressed Widening QRS
    QT interval increased Prolonged PR, Lengthening QT
    U Waves prominent Diminishing size of P & R waves
    Depressed ST Segment

    Hypocalcaemia Hypercalcaemia
    QT prolonged. QT shortened
    ST Segment unchanged Cardiac arrhythmias
    Enhances effect of hypokalaemia

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