Demystifying the Pediatric ECG

  Emergency physicians are able to quickly decode the ciphers of ECGs into meaningful clinical data, at least until they are faced with a pediatric ECG. It breaks their pattern recognition, and they are forced to use the slow part of their brain (recommended reading: Daniel Kahneman’s Thinking, Fast and Slow). Even though the pediatric ECG looks vaguely similar to all of the other ECGs seen during a shift, this one turns into a mystery and confidence drains. It doesn’t look normal based on an adult tracing, but they are unsure if it’s normal for the child. The best ECG readers can resort to folding the tracing underneath and relying on the computer read. But we might make the ECG a little less mysterious if we can decipher the differences of the pediatric heart.   Heart Rate: The heart rate increases during the first month of life because of increasing autonomic drive, and then it gradually decreases over years to a normal adult rate driven by changes in intrinsic sinus node activity. Despite these changes, the cardiac output does not change much. The heart rate is slowing and the left ventricle is enlarging, but the product (stroke volume x heart rate) remains relatively constant.   P Waves: Atrial depolarization indicated by the P wave starts at the SA node and proceeds inferiorly and to the left toward the AV node, the same as in adults. This means the P wave should be positive in lead I and aVF. The infant heart is usually aligned more vertically in the chest, so...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs