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:

• LitFL - Paediatric ECG Interpretation

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.

• Calabrò MP1, Barberi I, La Mazza A, Todaro MC, De Luca FL, Oreto L, Russo MS, Cerrito M, Bruno L, Oreto G. Bifid T waves in leads V2 and V3 in children: a normal variant. Ital J Pediatr. 2009 Jun 26;35(1):17.

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

• Paediatric ECG Interpretation 

Textbook

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