AN APPROACH TO PEDIATRIC ECGS

Refer to age and gender normative ECG data by Rinjbeek et al (2001)

1. ID / Calibration 5. Intervals
• PR Interval (II)
• ID (Patient, age, date) • Prolonged: heart block
• Calibration • Shortened: WPW
• QRS Duration (V5)
• Prolonged: Conduction
delay
2. Rate • QTc Interval (II or V5)
• <0.44 sec
• <0.47 sec (infancy)

• Count off Method

• R-R distance 6. Voltages
• 60 ÷ measured RR (sec)
• Right Atrial Hypertrophy
• 6/10 sec rule
• Full R-R segments in 6 sec X • P waves >3mm in any lead
10. (X 6 if 10 sec) • Left Atrial Hypertrophy
• ECG Ruler • P waves >0.10 sec in any lead (>0.08 sec in
infants)
• Broad notched P waves
3. Rhythm • Biphasic P wave in V1
• QRS after every P • Ventricular Hypertrophy Criteria:
• P before every QRS • Precordial leads reflecting the hypertrophied
• P axis between 0 and +90 ventricle show:
• Upright P waves in I, II, aVF • Abnormally large QRS complexes
• Negative P waves in aVR • Abnormal R/S wave ratio
• QRS axis deviation

4. Axis 7. Repolarization
Normal changes:
• Right axis dominance at birth
• Inverted T waves in V1, V2, V4R from day 7 to
• Gradual progression to left with
8-10 years old
age
• ST elevation/ depression
• 1mm in limb leads
• 1-2mm in precordial leads
• Early Repolarization if:
• ST elevation/depression concordant with the
• Use I and aVF to T wave
localize the quadrant • Large symmetrical T waves
• Axis is perpendicular • J waves
to most iso-electric
lead

March 2020
Eric King (Medical Student, University of Alberta) for www.pedscases.com