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Understand the age-related differences in the pediatric ECG and the expected changes in the pediatric 12-lead ECG
We believe that some of the abnormalities of adult electrocardiogram are completely normal on children's electrocardiogram. These characteristics vary with the age of the child.
In the fetus, due to patent ductus arteriosus, most of the circulation through the lungs is bypassed. This means that the right ventricle is dominant, and the right ventricle is larger and thicker than the left ventricle. After birth, the PDA is closed and the left ventricle gradually dominates.
The electrocardiogram of a newborn is similar to that of an adult with right ventricular hypertrophy.
As the child progresses from infancy to early childhood, ECG begins to reflect more of the left ventricular advantage.
As children grow older and enter puberty, the electrocardiogram is more like an adult's electrocardiogram. Some juvenile modes may persist.
These are the most common pediatric arrhythmias.
Common types of PSVT in children:
8 out of every 1,000 live births have congenital heart malformations. They are often found during prenatal check-ups.
Many pediatric heart diseases can cause abnormalities in the ECG, including:
Perform a 12-lead ECG on any pediatric patient with one or more of these signs or symptoms.
1. Known history of heart disease or family history of sudden cardiac death 2. Cyanosis 3. Loss of consciousness or seizures 4. Drug intake or other poisoning 5. Arrhythmia 6. Chest pain during exertion
Because the right ventricle is dominant in infants and young children, an additional V4 right ventricle should be made. You can do a second ECG check, or just use the V3 wire and mark it as "V4R", skip V3. The remaining precordial leads can be placed using the same bony landmarks as adults.
Limb electrodes should be placed on the extremities, close to the shoulders and buttocks, to reduce muscle artifacts. If you let a familiar caregiver hold the baby, you can reduce the baby's movement artifacts.
(Photo courtesy of Brooks Walsh)
As with adult electrocardiograms, the best way to determine which results are abnormal is to be familiar with normal conditions.
Learn more about pediatric ECG acquisition and interpretation from these articles.
Dawn Altman, RN, EMT-P is the administrator/owner of the website ECGGuru.com, which provides resources for lecturers on ECG and heart topics; and ECG Guru, Inc., a health education and consulting company, for all healthcare professionals The staff provides ECG courses from elementary to advanced.
She is a well-known ECG coach, specializing in EMS training; and an RN with rich experience in emergency department, EMS, PACU, family health and catheterization laboratory admissions and rehabilitation. She has consulting experience as a legal nurse consultant and a book reviewer.
All materials on ECG Guru are of high quality, without copyright, and can be downloaded for free for teaching. Contact Altman at ECGGuru@gmail.com.
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