The ECG below is taken from a 4 year old boy who has presented with multiple episodes of syncope after sustaining a head injury in a fall of <1m.

Looking at the ECG as a whole……

And yes thank you (acknowledges editing skills)

Interpretation:

• Rate: 84
• Rhythm: Sinus arrhythmia
• Axis: Normal
• Morphology:
  • R wave V6 = 50 (mean 15)
  • S wave V1 = 45 (mean 10)
• Intervals: PR 140 QRS 80
• Summary: LVH voltage criteria

Clinical Closure: went on to have Echo showing no LVH, only tiny PFO with left to right flow.

Changes in Paediatric ECGs:

• The move from a RV dominant to LV dominant system occurs in the first 6 months of life
• Less cardiac muscle may mean shorter PR and QRS intervals
  • expect WRS of <80 up to 8 yo
  • (can make it easier to mistake VT for SVT)
• TWI of infancy NOT seen in the first week of life but can persist into adulthood
• QTc of 490 is normal up to 6 mo

Further Reading – Textbook:

Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.