I II III Pediatric ECG Arrhythmia diagnosis and
- Slides: 50
I II III
ทำไมเราตองเรยน “Pediatric ECG”? • Arrhythmia diagnosis and management • Provides clues for the diagnosis of CHD • Indicative of other associated problems • May identify some discrepancies of the diagnosis prompting further testing or a more careful review of the existing data
Characteristics for evaluating of ECG
Normal ECG
0. 04 seconds
0. 20 seconds
Standardize
R-wave q-wave
R-R interval p-p interval
0 -7 days Heart rate 90 -160 1 wk– 1 m 100 -175 P-R interval QRS duration 1 m-6 m 6 m-1 yr 110 -180 100 -180 0. 08 -0. 15 70 -180 45 -160 10 -15 yr >15 yr 70 -160 65 -140 60 -130 60 -100 0. 09 -0. 18 0. 10 -0. 20 0. 04 -0. 09 0. 06 -0. 09 5 -110 10 -120 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 5 -10 yr 0. 04 -0. 08 0. 03 -0. 07 QRS axis 1 yr-5 yr 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
Heart rate 0 -7 days 1 wk– 1 m 1 m-6 m 6 m-1 yr 1 yr-5 yr 5 -10 yr 10 -15 yr >15 yr 90 -160 100 -175 110 -180 100 -180 70 -160 65 -140 60 -130 60 -100 0. 08 -0. 15 P-R interval QRS duration 0. 04 -0. 08 0. 03 -0. 07 QRS axis 70 -180 45 -160 10 -120 0. 04 -0. 09 0. 06 -0. 09 5 -110 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 0. 09 -0. 18 0. 10 -0. 20 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
Heart rate 0 -7 days 1 wk– 1 m 1 m-6 m 6 m-1 yr 1 yr-5 yr 5 -10 yr 10 -15 yr >15 yr 90 -160 100 -175 110 -180 100 -180 70 -160 65 -140 60 -130 60 -100 0. 08 -0. 15 P-R interval QRS duration 0. 04 -0. 08 0. 03 -0. 07 QRS axis 70 -180 45 -160 10 -120 0. 04 -0. 09 0. 06 -0. 09 5 -110 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 0. 09 -0. 18 0. 10 -0. 20 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
Heart rate 0 -7 days 1 wk– 1 m 1 m-6 m 6 m-1 yr 1 yr-5 yr 5 -10 yr 10 -15 yr >15 yr 90 -160 100 -175 110 -180 100 -180 70 -160 65 -140 60 -130 60 -100 0. 08 -0. 15 P-R interval QRS duration 0. 04 -0. 08 0. 03 -0. 07 QRS axis 70 -180 45 -160 10 -120 0. 04 -0. 09 0. 06 -0. 09 5 -110 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 0. 09 -0. 18 0. 10 -0. 20 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
Heart rate 0 -7 days 1 wk– 1 m 1 m-6 m 6 m-1 yr 1 yr-5 yr 5 -10 yr 10 -15 yr >15 yr 90 -160 100 -175 110 -180 100 -180 70 -160 65 -140 60 -130 60 -100 0. 08 -0. 15 P-R interval QRS duration 0. 04 -0. 08 0. 03 -0. 07 QRS axis 70 -180 45 -160 10 -120 0. 04 -0. 09 0. 06 -0. 09 5 -110 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 0. 09 -0. 18 0. 10 -0. 20 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
Heart rate 0 -7 days 1 wk– 1 m 1 m-6 m 6 m-1 yr 1 yr-5 yr 5 -10 yr 10 -15 yr >15 yr 90 -160 100 -175 110 -180 100 -180 70 -160 65 -140 60 -130 60 -100 0. 08 -0. 15 P-R interval QRS duration 0. 04 -0. 08 0. 03 -0. 07 QRS axis 70 -180 45 -160 10 -120 0. 04 -0. 09 0. 06 -0. 09 5 -110 0 QRS V 1 Q R 5 -25 3 -22 3 -20 2 -18 1 -15 1 -12 1 -6 S 0 -22 0 -16 0 -15 1 -20 3 -21 2 -22 3 -13 0 -5 0 -3 0 -2 10 -35 13 -38 10 -35 7 -21 1 -10 0 -5 0 -3 0 -2 8 -24 5 -18 QRS V 5 Q 0 -1 0 -3 R 2 -20 3 -25 5 -30 10 -30 S 2 -19 2 -16 1 -14 QRS V 6 Q 0 -2 R S Maximum QTc 0. 09 -0. 18 0. 10 -0. 20 1 -12 1 -17 0 -9 0. 45 1 -13 0 -3 3 -20 1 -11 0 -4 5 -22 6 -22 0 -7 0 -6 8 -25 0 -4 0. 44 0 -2 0. 43
I V 1
Right Ventricular Hypertrophy (RVH) • • R-wave in the right chest leads > 98 percentile for age S-wave in the left chest leads > 98 percentile for age Abnormal R/S ratio in the right chest leads q. R pattern in the right chest leads rs. R or r. R pattern in the right chest leads Abnormal t-wave direction in the right chest leads Right axis deviation
Left Ventricular Hypertrophy (LVH) • • • R-wave in the left chest leads > 98 percentile for age S-wave in the right chest leads > 98 percentile for age Abnormal R/S ratio in the left chest leads Deep Q in the left chest leads Abnormal t-wave direction in the left chest leads Left axis deviation
Combined Ventricular Hypertrophy (CVH) • Signs of LVH + RVH • R+S-wave amplitude in V 2 to V 5 > 60 mm
