Wednesday, 21 March 2012

ECG of the Week - 19th March 2012 - Interpretation

This weeks ECG is from a 7yr old.



Click to enlarge


Rate:
  • 95-100
Rhythm:
  • Sinus Rhythm
  • Regular

Axis:
  • Normal (80 deg)
Intervals:
  • PR - Short (~80-100ms)
  • QRS - Prolonged (100-120ms)
  • QT - 320ms (QTc Bazette ~ 400 ms)
Segments:
  • Normal

Additional:
  • T Inversion V1, aVR
  • Biphasic T wave V2
  • RSR' Pattern V1
  • ? Slurring QRS - II,III, V4


Interpretation:
  • T wave changes
  • Prominent R waves V5-6 (less than age adjusted upper limit)
  • RSR' Pattern V1
  • Short pr interval
  • QRS Prolongation - QRS duration > 80ms in children <8yrs is abnormal
  • S wave aVL - ? pseudo-infarction pattern
  • Possible slurring QRS Upstroke
  • T wave and prominent R waves consistent with age
  • Features suggestive of Wolff-Parkinson-White
  • I don't have any further clinical information of this case as to the final diagnosis
 
  • Paediatric ECGs are challenging with normal intervals and morphology differing from both adult ECGs and by patient age.
  • If in doubt as to the presence of pathology review of the ECG by a paediatric cardiologist is desirable

References / Further Reading

 
Life in the Fast Lane

  • Paediatric ECG here
  • Wolff-Parkinson-White here
Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.