ECG of the Week – 12th May 2021 – Interpretation

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3 y/o boy admitted via ED for viral induced wheeze as he was requiring ongoing bronchodilator therapy and supplemental oxygen. An ECG was done as child had a rapid pulse.

Q1  Describe and Interpret the above ECG?

Q2 List some electrocardiographic features may be normal in children?

Q3 What are some common indications for performing Paediatric ECGs?

 

ANS:

Rate:

  • ~126 bpm

Rhythm:

 

  • Sinus rhythm
  • Subtle sinus arrhythmia

Axis:

  • Normal (~85 deg)

Intervals:

  • PR – Normal for age (100ms)
  • QRS – Normal (80ms)
  • QT – 280ms (QTc Bazette 420 ms)

Additional:

  • rSr’ pattern V1
  • Baseline artefact
  • P wave in II notched but normal height (<3mm) and duration (<90ms)
  • U wave in lead V3
  • Apparent high voltageds in precordial leads
    • Leads II.III,V1,V5,V6 within normal limits for age adjustment

Interpretation:

  • Normal age adjusted ECG

ECG features in Children 3-8 years that are normal:

3 – 8 years

  • Adult QRS progression in praecordial leads: dominant S in V1, dominant R in V6
  • Large praecordial voltages persist
  • q waves in left chest leads may be large (<5mm)
  • T waves remain negative in right praecordial leads

 

The following electrocardiographic features may be normal in children:

  • Heart rate >100 beats/min
  • Rightward QRS axis > +90°
  • T wave inversions in V1-3 (“juvenile T-wave pattern”)
  • Dominant R wave in V1
  • RSR’ pattern in V1
  • Marked sinus arrhythmia
  • Short PR interval (< 120ms) and QRS duration (<80ms)
  • Slightly peaked P waves (< 3mm in height is normal if ≤ 6 months)
  • Slightly long QTc (≤ 490ms in infants ≤ 6 months)
  • Q waves in the inferior and left precordial leads

 

 

Some Common Indications for performing Paediatric ECG in ED:

  • Syncope, seizures and “funny turns”
  • Cyanotic episodes
  • Chest pain or other symptoms related to exertion
  • Drug ingestion
  • Diagnosis and management of rheumatic fever, Kawasaki’s disease, pericarditis, myocarditis
  • Diagnosis and management of arrhythmia
  • Diagnosis and management of congenital heart disease
  • Family history of sudden death or life threatening event
  • Electrolyte abnormalities.

References / Further Reading:

Paediatric ECG Interpretation

 

https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/ECG-interpretation

Thank you Dr Larkin. ECG taken from Dr J Larkin ECG of the Week Blog.