Paediatric ECG’s
www.paedcard.com
www.paediatriccardiology.uchicago.edu
Article: Sharieff, G, Rao, S, The Paediatric ECG
Emerg Med Clin N Am 2006:24; 195-208
Become more adult like around age 8
Usual lead placement usually sufficient
Variation in rate, axis, PR int, QRS duration/ R & S waves with age
Tables available (on Casey ED website)
RV dominance in infancy (up to 1-2mths)
T-inv V1-V3/4 (up to adolescence)
Arrhythmias
Ischaemia/infarcts uncommon
Indications for Paeds ECG
Chest pain
Suspected arrhytmia (infant with HR > 200, older shild with HR > 160)
Syncope/collapse
Drug exposure
Murmur
Electrolyte abnormailty
Electrical burn
Chest trauma
SVT
Commonest arrhythmia in kids
Peak in 1st 2 months!
Non-specific Syx
Fussy/irritable
Poor feeding
Pallor
Lethargy
Usually HR > 200
Treatment:
ABC/IV/02 etc
VAGAL: ice in plastic bag on face
Ice water in bucket – dunk baby in head first
Adenosine: 0.1mg/kg (incr by 0.1mg per shot) up to 0.5mg/kg
Can give up to 5 doses
DCR synchronised
Sinus tachy
SVT
Rate
Variability
P-axis
Return to SR
Associated
< 200
Varies
0-90 degrees
Gradual
Fever, pain etc
> 200
Fixed
Upright
Abrupt
Poor perfusion
CONGENITAL HEART DISEASE
1/100 live births
Often present in 1st 3 mths
ECG: chamber hypertrophy, conduction abnormalities
Duct dependent
1st 2 weeks, collapse
Coarctation, HLHL (hypoplastic left heart syndrome), Tetralogy
L  R shunt
1-3 mths
CCF, VSD, PDA, AVCD (AV canal defect)
Cyanotic
Variable ages
Cyanosis
Tetralogy, Pulmoanry stenosis, Truncus aretriosus
Prolonged QT Syndrome
QTc = QT/square root of RR
QTc > 0.44 = Increased risk of lethal arrhythmia (VF/VT)
Syncope/seizure/palps/arrest
Usually exercise/emotion
Abnormal Na+/K+ channel
LONG QT in KIDS
Usually congenital
Usually triggered by INCREASED HR ie exercise
LONG QT in ADULTS
Usually torsades triggered by DECREASED HR eg Drugs/AMI
Causes:
Autosomal recessive (+ deafness)
Autosomal dominant (no deafness)
Sporadic
Low Ca2+
Myocarditis
Cardiomyopathy
Drugs: TCA, Erythro, Anti-H1, Antifungals
Mx
Cardiol r/v
B-blockers (old treatment)
Implanted defib (new treatment)
Screen family
MYOCARDITIS
Coxsackie, Echo, ‘Flu
Lethargy, poor feedingm pallor, sweaty, tachypnoea, tachycardia
Hepatomegaly = best sign for CCF in kids
ECG: sinus tachy, frequent VE’s, Low QRS voltages, flat/inverted T’s