DR KIRAN VS

NARAYANA HRUDAYALAYA

BANGALORE

PEDIATRIC ECG IS SIMPLE!

WHY ME?

Conduction systemLeads and wavesHow to report?Why ECG alone is useless?How to diagnose with help of ECG?How to evaluate arrhythmias?Answer to win!Conclusion!!

WHAT IS THERE?

CHEST LEADS PLACEMENT

NORMAL ECG

Standardization: 10 mm high so that 10 mm = 1 mV.

Paper speed is correct.Heart rate: 1500/SMALL squaresIntervals: PR and QT intervals, width of the

QRS complexes.QRS axis: L1 and aVF

BASIC BEGINNING

How to analyse?P: there or not? RatePP: Regular or not?PR: normal or short?QRS: Follows P? RateQRS: narrow or wide?RR: Regular or not?ST: Normal or not?QT: Normal or long?Put them together

Normal Sinus Rhythm

HOW TO REPORT ECG: WRITE AND PRACTICE!!

AXIS DETERMINATION

INSTANT AXIS!

ATRIAL ENLARGEMENT

NEVER diagnose only on ECG!ECG

Clinical data

ECG

Diagnosis Prize!!

QUIZ WITH PRIZES!

RATE, RHYTHM, AXIS, FORCES

4-mo old boyCyanotic, SO2 80%No spellsESM LUSBYour diagnosis:

CLINICAL DATA

ANSWER?

Sinus tachycardia, LAD, LV forces: TRICUSPID ATRESIA

INTERPRET THE ECG: NO DIAGNOSIS!

14-year old girlAsymptomatic nowIntermittent palpitations, no syncopeSO2: 94%Split S2, multiple heart sounds, no murmursDiagnosis?

CLINICAL DATA

ANSWER?

Sinus, Tall P, splintered QRS: Ebstein anomaly

READ THE ECG

6-year old boyAsymptomaticSO2: 98%RV apexNo clickS2 spilt not well appreciatedESM LUSBYour diagnosis in light of ECG?

CLINICAL DATA

DIAGNOSIS?

Sinus, RAD, RV Forces: SEVERE PULMONIC STENOSIS

READ THE ECG

7-day old girlTachypneoa with recessionsSO2 88% Split S2ESM LUSBYour diagnosis

CLINICAL DATA

YOUR DIAGNOSIS?

Sinus tachycardia, RAD, rsR’ in V1, V2, RV forces: TAPVC

INTERPRET THE ECG: NO DIAGNOSIS

1-year oldCyanoticSO2: 78%ClubbingS2 singleESM LUSBYour diagnosis

CLINICAL DATA

YOUR DIAGNOSIS

Sinus, RAD, RV forces, Early transition: TOF

INTERPRET THE ECG (CAN NEGLECT THE POINTERS)

3-month oldSevere LV dysfunctionPulmonary venous congestionCTR 70%LV EF 15%Your diagnosis?

CLINICAL DATA

YOUR DIAGNOSIS? (CAN CONSIDER POINTERS!)

Sinus, LAD, Deep Q in lat leads, ST down: ALCAPA

READ ONLY THE ECG

3-year old boyFailure to thriveDOES2 splitPSM at apexESM LUSBYour diagnosis?

CLINICAL DATA

YOUR DIAGNOSIS?

Sinus tachycrdia, LAD, Long PR, rsR’ in V1, V2, BV Forces: Primum defect with MR

ONLY THE ECG FINDINGS

NewbornSevere cyanosisLV apexS2 singleNo precordial murmurContinuous murmur at LUSBYour diagnosis

CLINICAL DATA

YOUR DIAGNOSIS?

Sinus tachycardia, RAD, RAE, BV forces: pulmonary atresia with intact IVS, ASD

ONLY THE ECG FINDINGS

1-day old boyTachypneoaFeeble pulsesNo R-F delayFeatures of shockRV apexYour diagnosis

CLINICAL DATA

YOUR DIAGNOSIS

Sinus tachycardia, RAD, RAE, RV forces, poor R progression: HLHS

ONLY ECG FINDINGS

18-year old boyExertional breathlessnessBaseline SO2: 88%, drops to 80% with

minimal effortRV apexLoud S2Your diagnosis

CLINICAL DATA

YOUR DIAGNOSIS

Sinus tachycardia, Sup axis, RAE, RV forces with strain: Eisenmengerization

ONLY ECG FINDINGS

8-year old girlHad cardiac surgeryAdditional procedure after 3 weeksAsymptomatic nowYour diagnosis?

CLINICAL DATA

YOUR DIAGNOSIS

AV dissociation, Sharp artefacts before each QRS, Sup axis, LBBB pattern: VVI Pacemaker with lead in RV

QTc INTERVAL & LQTS

Are there normal P waves present?Are the QRS complexes wide or narrow?What is the relationship between the P waves

and QRS complexes?Is the rhythm regular or irregular?

4Qs OF RHYTHM

ECG per-se is uselessAlways with clinical scenario“Treat the pt; not the ECG” is clichéTreat pt till ECG is OK!Get a good 12-lead ECG with Rhythm strip for

atleast 15 secondsGood luck with ECGs

REMEMBER

Arrhythmia ECGs need analysis “It looks like....?!” : rarely correctMore it looks normal, more it is likely to be

normal!Analysis of arrhythmia is more important than

giving it a named diagnosisNormal ECG is the most important one to learnTRY, PRACTICE, FAIL, RELEARN – ITS GOOD!!

That’s it!!

Hell is empty and all the devils are here. -- Wm. Shakespeare, "The Tempest"