arrhythmias.pptVIP

Interpretation of arrhythmias in the pediatric population Rajesh Shenoy, M.D. The Children’s Hospital at Montefiore Pediatric ECG Standardization Paper speed is 25 mm/sec 1 large square = 0.2 sec 1 small square = 0.04 sec Voltage 10 mm/mv Algorithm for reading ECGs Rhythm : Sinus or Non-sinus Rate: 1500/ R-R interval (mm) Axis: QRS axis T axis Waves: P wave (Atrial depolarization) QRS complex (Ventricular depolarization) ST segment T wave (Ventricular depolarization) U wave (Late phase of ventricular depolarization) Intervals: PR QRS QT/QTc Rate Calculate both the ventricular and atrial rate In sinus rhythm, both are the same Many methods Heart rate scale Adults: 300/(No. of large squares b/w R-R) Children:1500/(No. of small squares b/w R-R) Pediatric ECG – QRS Axis Hexaxial Reference System Pediatric ECG – Determining Axis Using the Hexaxial Reference System Normal axes Pediatric ECG – Whats the Axis? What is the QRS Axis in this ECG? Pediatric ECG – P Wave Tall P waves ( 3 mm) indicative of right atrial enlargement (P pulmonale) Wide P waves ( 0.10 sec) indicative of left atrial enlargement (P mitrale) Pediatric ECG – PR Interval Beginning of the P wave to beginning of QRS complex Normal PR interval 0 – 1 mo 0.12 1 – 6 mo 0.14 6 – 12 mo 0.14 1 – 3 yr 0.15 3 – 8 yr 0.17 8-12 yr 0.18 12 – 16 yr 0.19 Adult 0.21 Prolonged PR Myocarditis Rheumatic Fever Digitalis toxicity Hyperkalemia Short PR Preexcitation Pompe disease Pediatric ECG – QRS Complex Q wave is narrow (0.02 sec) and short (5 mv) Deep Q wave in left precordial leads = LVH Q waves present in right precordial leads = RVH QRS Duration Normal values 3 yrs 0.07 s 3 – 8 yrs 0.08 s 8 – 12 yrs 0.09 s 12 yrs 0.10 s Prolonged QRS Bundle branch block WPW syndrome R and S waves R/S progression: In older children, adolescents and adults – the R voltage increases, S voltage decreases Voltage: Useful in determining hypertrophy of ventricles Criteria for ventricular hypertrop