CVS RADIOLOGY

CARDIOMEGALY

 Causes

 Large VSD
 Large PDA

 Cardiomyopathy

 MR

 AR
ECG
 Rhythm
 Rate

 Axis

 Waves

 segments
12 LEADS OF ECG

6 chest leads V1-V6

3 limb leads I,II,III

3 augmented leads avR, avL, aVF

RHYTHM
DEFINITION OF NORMAL RYTHM

 Each QRS complex is preceded by a P wave at a regular

interval.

 Ist thing to be determined in ECG is rhythm

 If rhythm is irregullar, rate cannot be calculated

RATE
AXIS
WAVES
INTERVALS
HEART CHAMBERS
HYPERTROPHY
CRITERIA FOR LVH
1) LAD for the patient's age
2) QRS voltages in favor of the LV   
a) R in I, II, III, aVL, aVF, V5, or V6 greater than the upper
limits of normal for age
b) S in V1 or V2 greater than the upper limits of normal for
age
3) Abnormal R/S ratio in favor of the LV
 R/S ratio in V1 and V2 less than the lower limits of normal
for the patient's age
1) LAD FOR PATIENT AGE

Lead I = 0° Lead AVL = -30°

Lead II = +60° Lead AVR = -150°
Lead AVF = +90°
Lead III = +120°
SCREENING CRITERIA FOR RVH
1) RAD greater than +120° in any child over 1 month is
highly suggestive of RVH
2) Upright T in V1
 In patients > 3 days and < 6yr old
 Provided that the T is upright in the left precordial leads (V5,
V6)
3) Q wave in V1 always suggests RVH
4) S wave > R wave in Lead V6
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
 Normal P-wave amplitude is < 3mm (tall P waves = 
right atrial enlargement).
 Normal P wave duration is < 0.09 seconds in children
and < 0.07 seconds in infants (wide P waves = left atrial
enlargement).
 A combination of tall and wide P waves occurs in 
combined atrial hypertophy
ASSESSMENT
 A 5 hrs old infant
presented with cyanosis
and breathing
difficulty. HR 150 min. R/R was
70min. CVS…no murmur.

A) X ray finding?
B) Diagnosis?
C) management/?
 2 imp findings on x ray?

 diagnosis/

 Management
 CALCULATE THE RATE IN THIS ECG?
 DIAGNOSIS?

 CAUSES?
 SINUS TACHYCARDIA

 CAUSES

 FEVER
 STRESS

 EXERCISE
CALCULATE RATE?
CALCULATE RATE?
 What is the rhythm of this ECG?
 Tell 2 causes of pansystolic murmur

 How will you differentiate b/w two of these conditions?

 Name a cyanotic congenital heart disease without a heart
murmur/
 Which type of murmur is heard in TOF?
 HOW WILL YOU DIAGNOSE ATRIAL SEPTAL
DEFECT ON CLINICAL EXAMINATION?