EKG RNDS

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EKG RNDS

• and you grows up
• and you grows up
• and you grows up

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Goals

• Recognize a normal pediatric EKG and
• how it changes with age
• Recognize an abnormal pediatric EKG
• Learn about a few congenital abnormalities
• not about how to diagnose them by EKG

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NORMAL EXAMPLES
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Newborn here for cone shaped head
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2mo old here for a vomiting and diarrhea
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6yo slipped on the snow and cut his lip
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17 yo male with chest pain
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QRS AXIS

• RVH of the neonate, axis shifts L with
  development
• Axis at birth is 60-180
• 1yr onward 0-110

Infant 60-180
Toddler 0-110
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R-Wave Progression?

• RVH of the neonate regresses in the first few
  months
• R waves in the right precordium shrink
• R waves in the left precordium grow
• RgtS usually up to 3yrs of age

NEONATE
6yo
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T-waves

• V1Upright T wave is common in the first few days
  of life. Thereafter it suggests RVH.
• V2-3 Inverted in childhood (Juvenile T wave
  pattern). Becomes upright during years 3-10.
  Can persist (aka Persistent Juvenile T wave
  Pattern)
• V4-5 Should be upright in all age groups.

Adolescent/Adult
Child
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Q waves

• Seen in leads II, III, aVF, V5, V6
• Amplitude doubles in first few months, then
  declines back to newborn levels
• 0.6-0.8mV are normal for kids 6mo to 3yrs old
• qS is often seen in V1-V3 in young adults

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ST segments

• ST elevation is normal in adolescents
• Study of Air Force Recruits as young as 16 91
  had ST elevation of 1-3mm in at least 1
  precordial lead.
• ST elevation usually greatest in leads with
  larger S waves

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Male Pattern
BER
BER PJTW
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Normal Values
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The Toughies
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EB 5 mo female with failure to thrive, harsh
holosystolic murmur
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Same patient a few months later
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NN Newborn with poor feedingdysmorphic, ?
murmur
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Endocardial Cushion Defect/Complete AV Canal

• Common in Trisomy 21
• Present in Infancy with CHF/FTT
• EKG
• Left Axis Deviation
• AV block (complete or 1st degree)

Mitral
ASD
Tricuspid
VSD
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MK 2 mo female with respiratory distress and URI
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(No Transcript)
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References

• Dickinson, D. The Normal EKG in Childhood and
  Adolescence. Heart 2005 91 1626-1630.
• All EKGs in pink stolen from Tipple M.
  Interpretation of electrocardiograms in infants
  and children. Images Paediatr Cardiol 199913-13
  at http//www.health.gov.mt/impaedcard/issue/issue
  1/ipc00103.htm
• UTDOL
• Thanks for Sep Sekhavat for pedi EKGs