Basic Paediatric Ecg

Click to edit Master title style
INSTITUT JANTUNG NEGARA

National Heart Institute
Dr Marhisham Che Mood PCHC, IJN
The Anatomy the Heart Click to editof Master title style

The Sectional Anatomy of the Heart


The Coronary Circulation


The Coronary Circulation

Click to Heartbeat edit Master title style The

Heartbeat Needs two Types of Cardiac Cells

Contractile cells
Provide the pumping action
Cells of the conducting system

Generate and spread the action potential
The Click to Heartbeat edit Master title style

The Conducting System

Initiates and spreads electrical impulses in heart Two types of cells

Nodal cells Pacemaker cells Reach threshold first Set heart rate Conducting cells Distributes stimuli to myocardium

The Conducting System (contd)
Heart is self-exciting
Pacemaker cells establish heart rate Normal pacemaker is sinoatrial (SA) node Impulse spreads from SA node: Across atria To atrioventricular (AV) node To AV bundle and bundle branches Via Purkinje fibers to ventricles


The Conducting System of the Heart


Time = 0
SA node activity and atrial activation begin.
SA node

Stimulus spreads across the atrial surfaces and reaches the AV node.
AV node
Elapsed time = 50 msec
There is a 100-msec delay at the AV node. Atrial contraction begins. AV bundle Bundle branches Elapsed time = 150 msec
The impulse travels along the interventricular septum within the AV bundle and the bundle branches to the Purkinje fibers.
The impulse is distributed by Purkinje fibers and relayed throughout the ventricular myocardium. Atrial contraction is completed, and ventricular contraction begins. Elapsed time = 225 msec Purkinje fibers

Time = 0
SA node


Time = 0
SA node

AV node

Time = 0
SA node

AV node

Time = 0
SA node

AV node

Time = 0
SA node

AV node
The impulse is distributed by Purkinje fibers and relayed throughout the ventricular myocardium. Atrial contraction is completed, and ventricular contraction begins. Elapsed time = 225 msec Purkinje fibers

The Electrocardiogram (ECG or EKG)

A recording of the electrical activity of the heart Three main components

P wave Atrial depolarization QRS complex Ventricular depolarization T wave Ventricular repolarization

An Electrocardiogram

Click to edit Paper Master title style ECG

Click to edit Master title style The Heartbeat

Key Note

The heart rate is established by the SA node, as modified by autonomic activity, hormones, ions, etc. From there, the stimulus is conducted through the atrium to the AV node, the AV bundle, the bundle branches, and Purkinje fibers to the ventricular myocardium. The ECG shows the electrical events associated with the heartbeat.
Click to edit Master title style Lead Placement

The right arm or RA lead- directly below the clavicle & near the right shoulder The left arm or LA lead- directly below the clavicle & near the left shoulder The left leg or LL lead- on the left lower abdomen
Click to edit Master titleStrips style Steps to Interpreting Rhythm

1. Evaluate the P wave Are the P wave present? Indicates atrial depolarization Normal shape? Upright and round Are all the P wave the same shape? Do you see one P wave for each QRS complex?

2. Evaluate the Atrial Rhythm

Measure the interval between two consecutive P waves (P to P interval) Is the rate regular or irregular

3. Calculate the Heart Rate

Count the number of QRS complexes in a 6 second rhythm strip and multiply by 10
6 X 10 = 60

4. Calculate the duration of the PR interval

Count the number of small boxes from the beginning of the P wave to the beginning of the QRS complex and multiply by 0.04 seconds Does the PR interval fall within normal limits? Is the PR interval constant in each QRS cycle?

5. Evaluate the ventricular rhythm

Measure the interval between two consecutive R waves. This is the R to R interval Are the R to R intervals consistently the same? If the intervals are not the same, then the rhythm is considered irregular

6. Calculate the duration of the QRS complex

Count the number of small boxes from the beginning of the Q wave to the end of the S wave and multiply by 0.04 seconds Are the complexes all the same size and shape? Do any of the QRS complexes appear different from each other?
Is there one QRS complex for each P wave?

7. Evaluate the ST Segment

The normal ST segment is flat or isoelectric There can be an elevation or depression of 2mm or 2 small boxes. This can be considered normal in pediatrics. Abnormal changes are seen in pericarditis, myocardial ischemia or infarction
General Principles of Evaluating Click to edit Master title style Children with Arrhythmias

History: Does the fast or slow heart rate start and stop suddenly? Does it get worse with exercise? Are there other symptoms? difficulty breathing, pallor, cyanosis, dizziness, or poor feeding? What is the childs activity level? Family history
General Principles of Evaluating Click to edit Master title style Children with Arrhythmias How does the patient look? Is the patient breathing? Is there a pulse present?

Rhythms originating in the sinus node Click to edit Master title style (SA node)

Rhythms originating in the sinus node (SA node) are: Normal Sinus Rhythm Sinus Tachycardia Sinus Bradycardia
Click to editof Master title style Characteristics Sinus Rhythms

The characteristics are: There is a P wave preceding each QRS complex There is a regular PR interval And the P wave is upright in lead II
Click to Sinus edit Master title style Normal Rhythm

The normal rhythm for any age is sinus rhythm. The average heart rate for infants is 90 to 160 beats per minute and for children and teenagers, it is 65 to 100 beats per minute.
Click to edit Rate Master title style Average Heart (per minute)



Basic Paediatric Ecg

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Click to edit Master title style

INSTITUT JANTUNG NEGARA

Dr Marhisham Che Mood PCHC, IJN

The Anatomy the Heart Click to editof Master title style

INSTITUT JANTUNG NEGARA

The Anatomy the Heart Click to editof Master title style

INSTITUT JANTUNG NEGARA

The Anatomy the Heart Click to editof Master title style

INSTITUT JANTUNG NEGARA

Click to Heartbeat edit Master title style The

INSTITUT JANTUNG NEGARA

Heartbeat Needs two Types of Cardiac Cells

Cells of the conducting system

The Click to Heartbeat edit Master title style

INSTITUT JANTUNG NEGARA

Initiates and spreads electrical impulses in heart Two types of cells

The Click to Heartbeat edit Master title style

INSTITUT JANTUNG NEGARA

The Click to Heartbeat edit Master title style

INSTITUT JANTUNG NEGARA

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Elapsed time = 50 msec

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Elapsed time = 50 msec

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Elapsed time = 50 msec

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Elapsed time = 50 msec

Click to edit Master title style

SA node activity and atrial activation begin.

INSTITUT JANTUNG NEGARA

Elapsed time = 50 msec

The Click to Heartbeat edit Master title style

INSTITUT JANTUNG NEGARA

A recording of the electrical activity of the heart Three main components

The Click to Heartbeat edit Master title style

INSTITUT JANTUNG NEGARA

Click to edit Paper Master title style ECG

INSTITUT JANTUNG NEGARA

Click to edit Master title style The Heartbeat

INSTITUT JANTUNG NEGARA

Click to edit Master title style Lead Placement

INSTITUT JANTUNG NEGARA

Click to edit Master titleStrips style Steps to Interpreting Rhythm

INSTITUT JANTUNG NEGARA

Click to edit Master titleStrips style Steps to Interpreting Rhythm

INSTITUT JANTUNG NEGARA

Click to edit Master titleStrips style Steps to Interpreting Rhythm

INSTITUT JANTUNG NEGARA

Click to edit Master titleStrips style Steps to Interpreting Rhythm

INSTITUT JANTUNG NEGARA

Click to edit Master titleStrips style Steps to Interpreting Rhythm

INSTITUT JANTUNG NEGARA