Clinical Review ABC of clinical electrocardiography

Paediatric electrocardiography

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7350.1382 (Published 08 June 2002) Cite this as: BMJ 2002;324:1382
  1. Steve Goodacre,
  2. Karen McLeod

    General clinicians and junior paediatricians may have little experience of interpreting paediatric electrocardiograms. Although the basic principles of cardiac conduction and depolarisation are the same as for adults, age related changes in the anatomy and physiology of infants and children produce normal ranges for electrocardiographic features that differ from adults and vary with age. Awareness of these differences is the key to correct interpretation of paediatric electrocardiograms.

    Successful use of paediatric electrocardiography

    • Be aware of age related differences in the indications for performing electrocardiography, the normal ranges for electrocardiographic variables, and the typical abnormalities in infants and children

    • Genuine abnormality is unusual; if abnormality is suspected, seek a specialist opinion

    Indications for paediatric electrocardiography

    • Syncope or seizure

    • Exertional symptoms

    • Drug ingestion

    • Tachyarrhythmia

    • Bradyarrhythmia

    • Cyanotic episodes

    • Heart failure

    • Hypothermia

    • Electrolyte disturbance

    • Kawasaki disease

    • Rheumatic fever

    • Myocarditis

    • Myocardial contusion

    • Pericarditis

    • Post cardiac surgery

    • Congenital heart defects

    Recording the electrocardiogram

    To obtain a satisfactory recording in young children requires patience, and the parents may be helpful in providing a source of distraction. Limb electrodes may be placed in a more proximal position to reduce movement artefacts. Standard adult electrode positions are used but with the addition of either lead V3R or lead V4R to detect right ventricular or atrial hypertrophy. Standard paper speed (25 mm/s) and deflection (10 mm/mV) are used, although occasionally large QRS complexes may require the gain to be halved.

    Paediatric electrocardiographic findings that may be normal

    • Heart rate >100 beats/min

    • QRS axis >90°

    • Right precordial T wave inversion

    • Dominant right precordial R waves

    • Short PR and QT intervals

    • Short P wave and short duration of QRS complexes

    • Inferior and lateral Q waves

    Indications for electrocardiography

    Chest pain in children is rarely cardiac in origin and is often associated with tenderness in the chest wall. Electrocardiography is not usually helpful in making a diagnosis, although a normal trace can be very reassuring to the family. Typical indications for paediatric electrocardiography include syncope, …

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