ECG (peds)

This page is for pediatric patients. For adult patients, see: ECG (main)

Ventricular rate

• Younger/smaller --> higher metabolic rate + lower vagal tone --> faster HR

Axis

• Right axis normal in first 6 months of life
  • Blood shunted away from pulm vasculature in utero, higher pulmonary pressures--> relatively thicker RV --> Right axis
• Extreme superior axis
  • Axis of -90 - 180 degrees
  • Seen with AV canal or atrial septal defects
• AVF lead vector
  • Negative QRS vector in AVF seen in some cardiac malformations (e.g. AV septal defects, single ventricle
  • Biphasic QRS in AVF can be normal but should be reviewed by peds cards cardiology review. [Evans, 2010]

Intervals

• Age dependant norms
• Smaller muscle mass--> shorter PR
• QTc longer in infants <6mo

T-wave inversions

• T-wave inversions in anterior precordial leads are normal
• T-waves upright in most leads for first 7 days of life
• T-waves typically inverted from 7 days to adolescence
• Once an individual child's T-waves flip upright, they should stay that way (i.e. to become newly inverted again would be pathologic)

Voltage/Ventricular hypertrophy

• Smaller pediatric chest wall --> EKG leads closer to heart --> exagerated voltages
  • V2-V5 most likely to appear high voltage
  • EKG auto-interpretations may "over-report" left or right ventricular hypertrophy
• LVH (quick/dirty method)
  • If R of V6 intersects with baseline of V5--> abnormal
• RVH indicators
  • Upright T-wave in V1 after 7 days of life
  • If RSR' present; R' taller than R wave
  • Pure R wave in V1 in child >6mo

See Also

• ECG (main)
• Congenital heart disease
• PALS (Main)

External Links

• https://pedemmorsels.com/pediatric-ecg/
• https://litfl.com/paediatric-ecg-interpretation-ecg-library/