Written by Esteban Davila MD and reviewed by Eric Tang MD.
Last updated 10/28/24
Learning Objectives:
- Utilize understanding of anatomical changes of the heart from birth to adulthood and apply it to ECG interpretation
- Recognize common patterns of normal pediatric ECGs, and differentiate those that fall out of this pattern
Resources
- Free:
- Pediatric Cardiology Part 2
- LITFL: Normal Pediatric ECG
- How to interpret an electrocardiogram in children
- Good book but $$
Why do I, an Emergency Physician, need to interpret a pediatric ECG? Can’t I just call Pediatric Cardiology?
Do you have one on speed dial? If not, it can be helpful to know how to interpret normal from abnormal.
I’ve never received any training on this, how would I be expected to interpret these?
That’s what we are here for. Thankfully, pediatric ECGs tend to follow particular rules. Those that don’t usually have some underlying abnormality that you can pick out. Let’s dive in. We’ll use a Rate, Rhythm, Axis, Interval approach with associated rules that ECGs should follow, then discuss more specialized topics
Rate
As we know, pediatric patients have a baseline higher heart rate from an increased metabolic rate and decreased influence of vagal tone; don’t need to belabor this point much
Rhythm
These are general tips for all ECG interpretation
Axis
Intervals
PR Interval
QRS Interval
QT Interval
Q Waves
A pediatric specific rule
R Wave Progression
T Waves
- Think of abnormal T waves as representing some form of increased pressure (strain). To make things easier, only focus on V1-V3 and V6 separately
KCHC/Downstate residents: Please also submit a New Innovations request with five key learning points for triple I credit