Pediatric ECGs - Dr. Bryant

• Normal Peds EKG Variations
  • Right heart dominance 
    • From infancy to adulthood ventricular dominance transitions from a relatively thicker RV in utero/infancy to thicker LV as adults
    • Right axis deviation 
    • Tall R waves in V1-V3
    • RSR' in V1
    • Deep S waves and Q waves in lateral leads
    • Juvenile T wave pattern in V1-V3
  • Small cardiac size = shorter intervals, faster rate
  • J-point depression
  • Early repolarization
  • Sinus arrhythmia

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• NOT Normal Peds EKG Variations
  • Brugada Syndrome
    • EKG: Leads V1-V3
      • RSR’ with ST elevation
    • 3 Types
      • Type 1 – coved
        • Diagnostic
      • Type 2/3 – saddle-back
  • Arrhythmogenic Right Ventricular Dysplasia (ARVD)
    • EKG: Leads V1-V3
      • Epsilon waves
      • Inverted T waves
  • Catecholaminergic Paroxysmal Ventricular Tachycardia (CPVT)
    • EKG:
      • Normal baseline, bidirectional QRS polymorphic Vtach with exertion/excitement
  • Hypertrophic Obstructive Cardiomyopathy (HOCM)
    • EKG: Lateral leads
      • Dagger-like deep narrow Q waves
      • Deep narrow T wave inversions
      • +/- LVH, left axis deviation
  • Wolff-Parkinson-White (WPW)
    • EKG:
      • Delta waves
      • Wide QRS
      • Short PQ segment
  • Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA)
    • EKG:
      • Anterolateral ischemic changes
      • Lateral leads
        • Deep wide Q waves
        • T wave inversions
  • Long QT Syndrome
    • EKG:
      • QTc > 450ms
      • At risk for Torsade de Pointes/Vtach

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