Wednesday, 2 September 2015

ECG of the Week - 31st August 2015 - Interpretation

This week's ECG is from an 11yr old male who presented with chest pain in the setting of respiratory illness.



Click to enlarge

Rate:
  • 84 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Right Axis Deviation
Intervals:
  • PR - Normal (120ms)
  • QRS - Normal (100ms)
  • QT - 360ms
Additional:
  • Notching in the terminal portion of the T wave in leads V2&3 - not visible in other leads
  • Prominent R waves in right precordial leads - V1-3
Interpretation:

  • Normal paediatric ECG

Variations in Paediatric ECG features

The paediatric ECG has a range of normal variants that are different from the adult ECG and are also dependent on the child's age.
For a great overview of paediatric ECG variants and normal ranges check out:



What's happening in leads V2 & 3 ?

There is clear notching within the T wave in these leads that looks unusual. This is something I've seen in quite a few paediatric ECG and finally find some information from Calabro et al in the Italian Journal of Paediatrics.


In a group of 604 normal children bifid / notched T waves were seen in 18.3% of children, with a peak incidence in the 5yr old group with 53% exhibiting T wave changes in leads V2-3.

References / Further Reading

Life in the Fast Lane

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