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.