1. Pediatric ECG Dr.Emamzadegan

2. ECG 1.RATE 2.Rhythm 3.Axis 4. RVH,LVH 5. P;QT;ST- T change

3. ECG 1. NL ECG with age (1866) 2.13 lead (V3R or V4R) 3. T change( T pos … 48 hr ; Abnormal > 1w) 4.Axis in neon = +110 to +180 (RAD) 5.Prominent R in V1,V3R until 8 Y/O. 6. R : S ratio >1 in lead V4R until they are 4yr

4. ECG 7.The diagnosis of pathologic right ventricular hypertrophy is difficult in the 1st wk of life. 8. An adult electrocardiographic pattern seen in a neonate suggests left ventricular enlargement. 9. situs inversus: the P wave may be inverted in lead I.

5. ECG 10. Inverted P waves in Ieads II and aVF are seen in nodal or junctional rhythms. 11. Tall (>2.5 mm), narrow, and spiked P waves : PS; Ebstein;T At.; Cor pulmonale. 12. Broad P waves, commonly bifid and sometimes biphasic, are indicative of left atrial enlargement.(VSD;PDA;MS;MR)

6. ECG 13.Flat P waves = hyperkalemia. 14. RVH : (1) a qR pattern in the right ventricular surface leads; (2) a positive T wave in leads V3R-V4R and V1-V3 between the ages of 5 days and 6yr; (3) a monophasic R wave in V3R, VaR, or V1; (4) an rsR'pattern in the right precordial leads with the 2nd R wave taller than the initial one; (5) age corrected increased voltage of the R wave in leads V3R-V4R or the S wave in leads V6-V7, or both; (5) marked right axis deviation (>120 degrees in patients beyond the newborn period); (7) complete reversal of the normal adult precordial RS pattern; and (8) right atrial enlargement. At least two of these changes should be present to support a diagnosis of RVH.

7. ECG 15. Systolic overload (RV) : pure,tall R in V1,2 16. Diastolic overload : rSR‘ ; slightly increased QRS duration. 17. Mild to mod.PS …..rSR‘ in V1,2

8. ECG 18. LVH : ( 1 ) depression of the ST segments and inversion of the T waves in the left precordial leads (V5, V6, and V7), known as a left ventricular strain pattern-these findings suggest the presence of a severe lesion; (2) a deep Q wave in the left precordial leads; (3)increased voltage of the S wave in V3R and V1 or the R wave in V5-V7, or both.

9. ECG 19. Systolic overload (LV): ST-T change 20. Diastolic overload (LV) : Q,R & NL T 21. complere right bundle branch block : may be congenital or may be acquired after surgery for congenital heart disease, especially when a right ventriculotomy has been performed, as in repair of the tetralogy of Fallot.

10. ECG 22. Congenital left bundle branch block is rare; this pattern is occasionally seen with Cardiomyopathy. 23. Corrected Q-T interval (Q-Tc): > 0.45 is prolonged (hpokalemia;hypocalcemia; LQTS) 24. 1st-degree heart block : congenital, postoperative, inflammatory (myocarditis, pericarditis, rheumatic fever), or pharmacologic (digitalis).

11. ECG 25. ST elevation: a.early repolarization; b.Pericarditis; followed by abnormal T wave inversion c. Ischemic injury

12. ECG 26. ST depression: myocardial damage or ischemia, including severe anemia, carbon monoxide poisoning, aberrant origin of the left coronary artery from the pulmonary artery, glycogen storage disease of the heart, myocardial tumors, and mucopolysaccharidoses; cardiomyopathy

13. ECG 27. T Wave inversion: myocarditis and pericarditis, or either right or left ventricular hypertrophy and strain; Hypothyroidism may produce flat or inverted T waves in association with generalized low voltage. 28. In hyperkalemia, the T waves are commonly of high voltage and are tent- shaped.