Pediatric EKG

Arrhythmias CHD Ischemia/Infarction Miscellaneous (Drug, Electrolyte Abnormalities, …)

Pediatric EKG Screening Diagnosis Follow up

EKG Leads

Normal Values (Davignon)

P wave Atrial Depolarization Lead II Duration (≤3y max=0.09s, >3y max=0.1s) Amplitude (max=2.5mm) Lead V1 Axis Arrhythmias

P wave

QRS Complex Ventricular Depolarization Duration (V5) Amplitude (high, low if R+S ≤ 5mm for limb leads & ≤ 10mm for precordial leads) Axis Morphology (QRSR’)

T Wave Ventricular repolarization Amplitude ( high if ≥ 7mm in limb leads & ≥ 10mm in precordial leads ) Axis

T Wave Axis I,IIpositive after 48 hours aVfpositive after 5 days aVrnegative V3r, V1negative (6 days to 6 years) V6positive

T Wave

P Wave Axis Abnormalities

RVH qR (V1) Pure R (V1) T wave abnormalities (V1) R(V1) > P98 S(V6) > P98 R/S(V1) > P98 RSR’(V1) RAD (after 3 years of age)

RVH qR

RVH Pure R

RVH Progressive T wave abnormalities

RVH RSR’ 1 year at least 10mm Normal QRS duration

LVH ST segment & T wave abnormalities (I, II, aVf, V5, V6) R(V6) > P98 S(V1) > P98 R(V6)+S(V1) > P98 Deep q (V6) (> 4mm) LAD

LVH

BVH Criteria for both RVH & LVH RVH & normal forces of LV LVH & normal forces of RV R+S (mid-precordial leads) (Katz-Wachtel Index)

BVH * * *

Atrial Enlargement Lead II (2.5×2.5) Lead V1 (1×1)

RAE Tall P wave Large initial deflection (V1)

LAE Broad P wave Large terminal deflection (V1)

LAE

BAE Both Criteria

The End