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Paediatric ECG
CONTENTS
1. ECG
2. Use of Paediatric ECGs
3. Indications
4. ECG recording in children
5. Electrophysiology and anatomy
6. Reference System
7. Mechanic of tracing
8. Basic measurement
9. Normal ECGs
10. Normal values and interpretation
11. Common deviations from normal ECGs in children

Standard ECG
12

leads ECG

2. Use of Paediatric ECGs

1. To be aware of age related differences in ECG indications
2. To know normal ranges for ECG variables
3. Indications for a Paediatric ECG
Syncope/seizure
Exertional

symptoms
Drug ingestions
Tachyarrhythmia
Bradyarrhythmia
Cyanotic episodes
Syncope/seizure
Exertional symptoms
Drug ingestions
Tachyarrhythmia
Bradyarrhythmia
Cyanotic episodes
Heart Failure
Hypothermia Heart Failure
Hypothermia
Mnemonic form - PAEDS ECG + 2 Fs
P

pericarditis (or myocarditis), post cardiac

surgery
A arrhythmias (tachy or bradyarrhythmia)
E exertional symptoms
D drugs, disease (Kawasaki)
S syncope/seizure
E electrolyte disturbance
C cyanosis, contusion (myocardial), cold (hypothermia)
G congenital heart defects
2 Fs:
Fever (rheumatic)
Failure (heart)

4. ECG recording in children

Distract child
Limb electrodes proximal, less movement artifact
Standard adult positions, but add V3R or V4R to detect right ventricular or
atrial hypertrophy
5. Electrophysiology and anatomy

12-lead ECG provides spatial information about the heart's electrical activity in
3 approximately orthogonal directions.
Right
Superior
Anterior

to

Left
to
to

Inferior
Posterior

7. Mechanic of tracing
Small box = 1 x 1 mm
Large box = 5 x 5 mm
ECG 1

8. Basic measurement
Paper speed (horizontal boxes)Standard = 25 mm/sec

9. Normal ECGs

P wave
the sequentialactivation (depolarization) of the right and left atria
QRS complex
right and left ventricular depolarization (normally the ventricles are activated
simultaneously)

ST-T wave
ventricular repolarization
PR interval
time interval from onset of atrial depolarization (P wave) to onset of ventricular
depolarization (QRS complex)
QRS duration
duration of ventricular muscle depolarization
QT interval
duration of ventricular depolarization and repolarization
RR interval: duration of ventricular cardiac cycle (an indicator of ventricular
rate)
PP interval
duration of atrial cycle (an indicator of atrial rate)
10. Normal values and interpretation
Rate
Rhythm
Axis
Intervals
Atrial

enlargement
Ventricular hypertrophy
ST/T wave evaluation
Determination of amplitude
Amplitude of ECG deflections are important for interpretation.
Calibration gives the standardization of an ECG.

A - means 1 mV=10mm
B - means limb leads are in full standardization but precordial leads are half
standardized.
C - means both precordial leads and limb are in half standardization.
D - means limb leads are in half standardization but precordial leads are in 1/4
standardisation.
E and F - show using two times the full standardization.
ECG 2

Rate
Measured in beats per minute
Measuring RR interval directly
1. 60 / RR interval (in seconds)
2. 300 / number of big boxes between consecutive QRS complexes
3. 1500 / number of little boxes between consecutive QRS complexes
ECG 3

RR

intervalHow many seconds?

9x0.04 = 0.36 sec
60 / 0.36 = 167 bpm
How

many big boxes between R and R?

1.8 big boxes
300 / 1.8 = 167 bpm
How

many small boxes between R and R?

9 small boxes
1500/9 = 167 bpm
Count the heart rate.
ECG 4

In cases with irregular rhythm

To count

the number of beats in 6 second (30 big boxes)

To multiply by 10
ECG 5

Rhythm

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Sinus

rhythm
Tachyarrhythmia
Bradyarrhythmia
Atrioventricular block
Axis

QRS deflection

Axis

Lead 1
Positive
Positive
Negative

aVF
Positive
Negative
Positive

Negative

Negative

Normal
LAD
RAD
Extreme RAD or
LAD

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ECG 6

ECG 7

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ECG 8