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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Pediatric ECG Interpretation
Introduction
Electrocardiography (ECG) is a crucial tool for evaluating the heart's electrical activity, particularly in pediatric patients. However, reading ECGs in children requires an understanding of normal age-related variations, as their cardiovascular physiology is different from that of adults.
Key Differences Between Pediatric and Adult ECGs
- Higher Heart Rates: Infants and young children naturally have faster heart rates, often exceeding 100 beats per minute.
- Right Ventricular Dominance: Due to intrauterine circulation, newborns show a rightward electrical axis and increased right ventricular forces, which gradually shift with age.
- Shorter PR and QT Intervals: Children have faster conduction times due to higher baseline heart rates.
- Variation in QRS Axis: The QRS axis in neonates is often rightward but normalizes as the child grows.
- T-wave Changes: Inversion of T-waves in anterior leads (V1-V3) is common in children until adolescence and should not be mistaken for pathology.
Common Pediatric ECG Abnormalities
- Congenital Long QT Syndrome: Prolonged QT interval can predispose to life-threatening arrhythmias.
- Wolff-Parkinson-White (WPW) Syndrome: Presence of delta waves suggests pre-excitation pathways.
- Hypertrophic Cardiomyopathy: Deep Q waves and repolarization abnormalities may suggest this condition.
- Congenital Heart Block: Often seen in neonates with maternal autoimmune disease.
- Arrhythmias: Supraventricular tachycardia (SVT) is the most common pediatric arrhythmia.
When to Refer to a Pediatric Cardiologist
- Unexplained syncope or seizure-like episodes.
- Family history of sudden cardiac death.
- Persistent QT prolongation or features suggestive of WPW.
- Symptoms such as chest pain, palpitations, or dizziness associated with ECG changes.
Conclusion
Pediatric ECG interpretation requires knowledge of age-specific normal values and recognition of common abnormalities. In case of doubt, referral to a pediatric cardiologist is advised.
Source recommendations
1. American Heart Association Guidelines on Pediatric ECG Interpretation
- https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
- https://elearning.heart.org/courses
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
- https://www.ahajournals.org/doi/10.1161/CIRCEP.119.008253
- https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc_guidelines_english.pdf
2. European Society of Cardiology Guidelines on Pediatric Arrhythmias
- https://academic.oup.com/eurheartj/article/43/40/3997/6675633
- https://pubmed.ncbi.nlm.nih.gov/26320108/
- https://academic.oup.com/eurheartj/article/36/41/2793/2293363
- https://pubmed.ncbi.nlm.nih.gov/36017572/
- https://www.escardio.org/The-ESC/Press-Office/Press-releases/Consensus-statement-on-paediatric-arrhythmias-released-by-ESC-and-AEPC
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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