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
- Steve Goodacre,
- 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, …
Log in
Log in using your username and password
Log in through your institution
Subscribe from £184 *
Subscribe and get access to all BMJ articles, and much more.
* For online subscription
Access this article for 1 day for:
£50 / $60/ €56 (excludes VAT)
You can download a PDF version for your personal record.