Pediatric ECG https://www.ecgguru.com/taxonomy/term/329/all en Pediatric ECG: One month old infant https://www.ecgguru.com/ecg/pediatric-ecg-one-month-old-infant <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/pediatric-ecg-one-month-old-infant"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/091323%20One%20month%20%20ECG%20from%20Cody%20Davis%20on%20Guru%20Edit_0.jpg" width="1800" height="1174" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" style="text-align: left; line-height: normal; background: white;" align="left"><strong><span style="font-family: 'Arial',sans-serif; color: #00b050;">The patient:</span></strong><span style="color: black; mso-color-alt: windowtext;"><span style="mso-spacerun: yes;">    </span></span><span style="font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: #222222; mso-font-kerning: 0pt; mso-ligatures: none;">4 week old female infant with past medical history of meconium aspiration at birth with APGAR scores of 2,4,6. Intubated and given nitric oxide for pulmonary hypertension. Weaned in NICU over 10 days. Echocardiogram during that time showed stiff pulmonic valve. This ECG was obtained at follow up appointment. Infant is eating well, no cyanotic spells. Four- week echo continues to show pulmonic valve stenosis. We do not know chamber measurements. Patient scheduled for a balloon valvuloplasty. </span><span style="color: #222222; font-family: Arial, sans-serif; font-size: 8pt;"> </span></p><p class="MsoNormal" style="text-align: left; line-height: normal; background: white;" align="left"><span style="color: #222222; font-family: Arial, sans-serif;">Babies are born with relatively symmetrical hearts.</span><span style="mso-spacerun: yes;">  </span><span style="color: #222222; font-family: Arial, sans-serif;">Unlike adult hearts, the right ventricle comparatively large due to the work it has to do to pump against the high pulmonary pressure before birth.</span><span style="mso-spacerun: yes;">  </span><span style="color: #222222; font-family: Arial, sans-serif;">Because newborns’ hearts are more to the right side, we often do right-sided chest leads in addition to the standard 12-lead ECG.</span></p><p class="MsoNormal" style="text-align: left; line-height: normal; background: white;" align="left"><span style="font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: #222222; mso-font-kerning: 0pt; mso-ligatures: none;"> </span><strong><span style="font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: #00b050; mso-font-kerning: 0pt; mso-ligatures: none;">The ECG:</span></strong><span style="font-family: 'Arial',sans-serif; mso-fareast-font-family: 'Times New Roman'; color: #222222; mso-font-kerning: 0pt; mso-ligatures: none;"><span>   </span>In spite of the pulmonary valve stenosis, this ECG is within normal limits for this 4-week old.</span><span style="color: #222222; font-family: Arial, sans-serif; font-size: 8pt;"> </span><span style="font-family: Arial, sans-serif; color: #222222;">Some of the ECG findings here that would be abnormal for an adult ECG, but are normal for this 4-week-old baby are:</span><span style="color: #222222; font-family: Arial, sans-serif; font-size: 8pt;"> </span></p></div></div></div> Wed, 27 Sep 2023 21:12:01 +0000 Dawn 872 at https://www.ecgguru.com SINUS ARRHYTHMIA https://www.ecgguru.com/blog/sinus-arrhythmia <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/sinus-arrhythmia"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Sinusarrhythmia.jpg" width="2900" height="1910" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p><span style="font-size: 10px;">Here we see the EKG of a 15-year-old girl. The rhythm is irregular, with the heart rate fluctuating between approximately 60 and 90 beats per minute. All P waves are identical, and the PR interval is always constant. Therefore, a sinus arrhythmia is present. In this case, it is a respiratory sinus arrhythmia, which is commonly found in younger individuals. The heart rate increases reflexively during inspiration and decreases during exspiration. This physiological sinus arrhythmia is usually no longer present in older individuals.</span></p> </div></div></div> Thu, 10 Aug 2023 07:07:34 +0000 Dr A Röschl 864 at https://www.ecgguru.com ECG OF A 3 YO BOY, IS IT NORMAL? https://www.ecgguru.com/blog/ecg-3-yo-boy-it-normal <div class="field field-name-field-blog-image field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/blog/ecg-3-yo-boy-it-normal"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/juvenile.jpeg" width="2871" height="1783" alt="" /></a></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even" property="content:encoded"><p>Here is the ECG of a 3-year-old boy. Is there cause for concern? The ECG shows a sinus rhythm with significant sinus arrhythmia. The heart rate increases with inspiration and decreases with expiration, which is called respiratory sinus arrhythmia. The QRS-axis is between 60 and 90 degrees, which is physiological at this age. The negative T-waves in V1-V3 (V4) are also age-appropriately normal. Therefore, there is no reason for concern; the ECG is considered normal for the child's age.</p> </div></div></div> Mon, 31 Jul 2023 10:17:32 +0000 Dr A Röschl 857 at https://www.ecgguru.com Narrow-complex Tachycardia In An Infant https://www.ecgguru.com/ecg/narrow-complex-tachycardia-infant <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/narrow-complex-tachycardia-infant"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/Peds100.jpg" width="1800" height="1227" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong><span style="font-size: 16.0pt; line-height: 107%; color: #00b050;">The patient:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt; line-height: 107%;">This ECG was obtained from a two-month-old girl who was a patient in the Emergency Department.<span style="mso-spacerun: yes;">&nbsp; </span>She had a fever due to a respiratory infection and was dehydrated. She was alert, active, and irritable.</span></p><p class="MsoNormal"><strong><span style="font-size: 16.0pt; line-height: 107%; color: #00b050;">The ECG:<span style="mso-spacerun: yes;">&nbsp; </span></span></strong><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">There is a narrow-complex tachycardia at a rate of 194 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>This is faster than the normal range for a two-month-old, which is about 80-160 bpm.<span style="mso-spacerun: yes;">&nbsp; </span>The intervals are all within normal range.<span style="mso-spacerun: yes;">&nbsp; </span>The frontal plane axis, at 145 degrees, is rightward, which is normal for this age. There are prominent, narrow Q waves in the inferior wall leads (II, III, and aVF) and in the left lateral leads (V4, V5, and V6).<span style="mso-spacerun: yes;">&nbsp; </span>There are no Q waves in the high lateral leads (I and aVL).<span style="mso-spacerun: yes;">&nbsp; </span>This is a normal pattern for this age group.<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span><a href="http://www.sciencedirect.com/science/article/pii/B9781416037743100280">www.sciencedirect.com/science/article/pii/B9781416037743100280</a></span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">The evaluation of this ECG must be preceded by a thorough evaluation of the patient.<span style="mso-spacerun: yes;">&nbsp; </span>SINUS TACHYCARDIA would be expected in the setting of fever, dehydration, hypoxia, pain or other discomfort. Should the rate fail to gradually return to a normal range after treatment, we would have to consider a reentrant supraventricular tachycardia. Reentrant tachycardias have a SUDDEN ONSET and SUDDEN TERMINATION.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: black; mso-themecolor: text1;">Unfortunately, we do not have follow up on the patient.</span></p></div></div></div> Tue, 26 Oct 2021 20:20:58 +0000 Dawn 808 at https://www.ecgguru.com Normal ECG in Seven-year-old Girl https://www.ecgguru.com/ecg/normal-ecg-seven-year-old-girl <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/normal-ecg-seven-year-old-girl"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/N%20110%20Normal%20ECG%207%20yo%20F.jpg" width="1800" height="640" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal"><strong style="mso-bidi-font-weight: normal;"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">The Patient:</span></strong><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;"><span style="mso-spacerun: yes;">   </span></span><span style="font-size: 12.0pt; line-height: 107%;">This ECG was obtained from a seven-year-old girl who was complaining of mild, non-specific chest pain.<span style="mso-spacerun: yes;">  </span>A medical workup found no structural or electrical abnormalities, and her pain resolved without treatment.<span style="mso-spacerun: yes;">  </span>This is a good ECG to illustrate some of the ECG findings that are normal at this age, which might not be normal in adults or in infants.</span></p><p class="MsoNormal"><span style="font-size: 12.0pt; line-height: 107%; color: #00b050;">The ECG: </span><span style="font-size: 12.0pt; line-height: 107%;">A general description of this ECG would include:</span></p><p class="MsoListParagraphCxSpFirst" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">         </span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 107%;">Normal sinus rhythm at 87 bpm</span></p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">         </span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 107%;">Normal frontal plane QRS axis at 60 degrees</span></p><p class="MsoListParagraphCxSpMiddle" style="text-indent: -.25in; mso-list: l0 level1 lfo1;"><!--[if !supportLists]--><span style="font-size: 12.0pt; line-height: 107%; font-family: Symbol; mso-fareast-font-family: Symbol; mso-bidi-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt 'Times New Roman';">         </span></span></span><!--[endif]--><span style="font-size: 12.0pt; line-height: 107%;">PR interval: <span style="mso-spacerun: yes;"> </span>.132 second (132 ms) </span></p></div></div></div> Fri, 07 Dec 2018 20:44:18 +0000 Dawn 762 at https://www.ecgguru.com Supraventricular Tachycardia in Pediatric Patient With Wolff-Parkinson-White Syndrome https://www.ecgguru.com/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/13M%20SVT%20WPW%20ECG2%20don%27t%20know%20time.jpg" width="1800" height="1141" alt="" /></a></div><div class="field-item odd"><a href="/ecg/supraventricular-tachycardia-pediatric-patient-wolff-parkinson-white-syndrome"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/image_2.jpg" width="1800" height="1141" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">This ECG was obtained from a 13-year-old boy who had previously been in NSR.  At that time, he was diagnosed with <a href="http://ecgguru.com/ecg/wolff-parkinson-white-syndrome-0">Wolff-Parkinson-White syndrome</a>, and he had delta waves.  He now presents with a supraventricular tachycardia.  People with W-P-W have one or more accessory pathways which allow atrial impulses to bypass the AV node and “pre-excite” the ventricles.  An accessory pathway, along with the normal pathway through the AV node, can form a functional circuit, allowing conduction to proceed down one pathway and return up the other, in a rapidly repeating circular motion.  This causes paroxysmal supraventricular tachycardia.<span style="font-size: 8pt;"> </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;">In W-P-W, the most common type of SVT is AV reciprocating tachycardia (AVRT), also called AV reentry tachycardia.  Conduction through the accessory pathway can be forward (anterograde) or backward (retrograde).  The most common type of reentrant conduction in W-P-W is <strong>ORTHODROMIC</strong>, which we see here.  The impulse conducts forward through the AV node, and backward over the accessory pathway.  There is no delta wave, as there is no pre-excitation of the ventricles.<span style="font-size: 8pt;"> </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 8pt;"><br /></span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><strong>Features of orthodromic AVRT are: </strong></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Fast rate (usually approximately 140-250 beats per minute)    </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">Narrow QRS complexes (unless BBB or IVCD present)   </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">P waves retrograde, if seen (negative in II, positive in aVR and V1)  </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px;">ST depression and T wave inversion common.</span><span style="font-size: 13.008px; line-height: 1.538em;"> </span></p><p class="MsoNormal" style="margin-bottom: .0001pt; line-height: normal;"><span style="font-size: 13.008px; line-height: 1.538em;"><br /></span></p></div></div></div> Tue, 01 Dec 2015 17:34:39 +0000 Dawn 679 at https://www.ecgguru.com ECG Basics: Retrograde P Waves https://www.ecgguru.com/ecg/ecg-basics-retrograde-p-waves <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-retrograde-p-waves"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/156%20nine%20yr%20old%20low%20atrial%20vs%20junct.jpg" width="1800" height="332" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This Lead II rhythm strip shows a regular rhythm with narrow QRS complexes and retrograde P waves. &nbsp;The strip was taken from a nine-year-old girl. &nbsp;The rate is about 110 per minute and the PR interval is .12 seconds (120 ms).</p><p>When retrograde conduction is seen in the atria, it is often assumed that the rhythm is originating in the junction. &nbsp;When a junctional pacemaker is initiating the rhythm, the atria and ventricles are depolarized almost simultaneously. &nbsp;This can produce a P wave in front of the QRS with a short PR interval, during the QRS, or after the QRS. &nbsp;Sometimes, in junctional rhythm, a block prevents the impulse from entering the atria, producing NO P wave. &nbsp;Junctional rhythms are usually slow "escape" rhythms, but can be accelerated or tachycardic.</p><p>The fact that this rate is 110 / minute and the PR interval is normal at .12 seconds, we should consider that this rhythm could also be from an ectopic pacemaker low in the atria. &nbsp;From this low starting point, the impulse will travel backward, in a "retrograde" fashion, through the atria, producing a negatively-deflected P wave in Lead II.</p><p>We do not have clinical data on this patient, and so do not know what possible causes of arrhythmia might be present, and what the expected rate should be in this situation. &nbsp;</p></div></div></div> Wed, 21 Oct 2015 04:28:03 +0000 Dawn 672 at https://www.ecgguru.com Pediatric ECG With Junctional Rhythm https://www.ecgguru.com/ecg/pediatric-ecg-junctional-rhythm <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/pediatric-ecg-junctional-rhythm"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/MR118%20Peds.jpg" width="1800" height="1404" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>This ECG, taken from a nine-year-old girl, shows a regular rhythm with a narrow QRS and an unusual P wave axis. Unfortunately, we do not have any clinical information. </p><p>Normally, P waves are positive in Leads I, II, and aVF and negative in aVR.  They can be biphasic in V1, but are usually positive in the rest of the precordial leads. . The P waves in this ECG are NEGATIVE in Leads I,II, III, aVF, and V3 through V6.  This indicates RETROGRADE conduction through the atria - the impulse starts low and continues in a backward fashion through the atria. This tells us that the rhythm originated in the AV junction or low atria.  The "junction" is usually defined as all of the complex AV node and the Bundle of His. </p><p>The literature over the years has been very confusing about the exact location of the "junctional" pacemakers.  One commonly-accepted guideline was that a rhythm is "junctional" if there are retrograde P waves with a short PR interval, or a P wave that occurs within or after the QRS.  A rhythm with a retrograde P wave and a NORMAL PR interval is said to be "low atrial", indicating that the ectopic pacemaker involved was located in the low atrium, producing retrograde conduction through the atria and normal delay through the AV node.</p><p><span style="line-height: 1.538em;">While both of these scenarios are plausible, it probably is not possible to say with certainty where the actual pacemaker is just by looking at the surface ECG.  The AV node has been found to have pacemaking capability in all three of it's regions, and the Bundle of His is also able to produce ectopic impulses.  PR intervals vary greatly, especially in pediatric patients, and can be influenced by heart size and heart rate.  The retrograde conduction through the AV node toward the atria can occur over the fast or slow pathways. The "major" junctional pacemaker is thought to be in the proximal Bundle of His.  Junctional or low atrial ectopic rhythms can occur because they override the rate of the sinus rhythm, following the rule that "The fastest pacemaker controls the heart".  junctional rhythms can also occur as "escape" rhythms, only occurring because the sinus impulse has failed or been vlocked - often due to AV block.</span></p><p>Since the exact location of the ectopic pacemaker in this case cannot be determined without electrophysiology studies, it is important to evaluate the effect, if any, the rhythm is having on the patient. Since there is a P wave before every QRS, and the QRS complexes are narrow, it can be assumed that there will be no clinical effect on this patient.  In addition, the rate is within normal range, and that is also unlikely to produce any clinical effect.</p><p>The causes of ectopic rhythms are many, and range from completely benign to serious.  So, this child should be evaluated in light of her symptoms, history, and physical assessment.</p></div></div></div> Tue, 07 Oct 2014 06:07:52 +0000 Dawn 601 at https://www.ecgguru.com Sinus Tachycardia in a Child https://www.ecgguru.com/ecg/sinus-tachycardia-child <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/sinus-tachycardia-child"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/N104.jpg" width="1800" height="1415" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>A six-year-old girl was found with her two younger siblings and her mother, unconscious, in a room filled with carbon monoxide. &nbsp;The mother had been using a charcoal grill inside the house. &nbsp;She managed to call 911 before losing consciousness, and the fire rescue paramedics broke into their house, saving them. &nbsp;This six-year-old required treatment in the pediatric intensive care unit, but recovered completely. &nbsp;The lesson for our students is to judge rate in the setting in which it is found. &nbsp;The heart rate here is 136/min. &nbsp;Normal for a child of six is usually between 80 and 100 at rest. &nbsp;This child is severely hypoxic, and she has sinus tachycardia. &nbsp;It would be a mistake to assume her rate is normal because "all children have fast heart rates". &nbsp;Also, children with sinus tachycardia can be so fast, they appear to have PSVT. &nbsp;The onset and offset can be excellent clues to the origin of the rhythm. &nbsp;Sinus rhythms can be expected to speed up and slow down gradually, unlike PSVTs, which have sudden onset and offset. &nbsp;The most important consideration is that sinus tachycardia usually has an APPARENT CAUSE: &nbsp;exercise, anxiety, hypoxia, hypovolemia, fear ,,,, the list is a long one. &nbsp;Once it is determined that the patient has sinus tachycardia, efforts usually focus on the elimation of the cause.</p><p>&nbsp;</p><p>We welcome any comments on this ECG, perhaps taking the discussion to a more advanced level.</p></div></div></div> Thu, 18 Jul 2013 05:02:59 +0000 Dawn 471 at https://www.ecgguru.com ECG BASICS: Sinus Tachycardia in a Toddler https://www.ecgguru.com/ecg/ecg-basics-sinus-tachycardia-toddler <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/ecg-basics-sinus-tachycardia-toddler"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/101%20Sinus%20tach%20child%20in%20PACU.jpg" width="1308" height="344" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Here is a nice example of sinus tachycardia taken from a 2-year-old in the post-anesthesia care unit after a short GI endoscopic procedure.&nbsp; Would you call this NSR, since it is from a child?&nbsp; The pre-op heart rate in this child was 120/min.</p><p>For your more advanced students, remind them that, in adults especially, a heart rate close to 150/min. should cause them to examine the ECG in several leads, looking for the presence of atrial flutter with 2:1 conduction.&nbsp; Another important teaching point, most ADULTS with sinus tach at 150/min. would&nbsp;&nbsp;manifest an obvious reason for the rapid heart rate (dehydration, pain, anxiety, shock, etc.)&nbsp; Challenge your basic students to come up with as many causes for sinus tach as they can.</p></div></div></div> Wed, 01 May 2013 23:24:56 +0000 Dawn 439 at https://www.ecgguru.com Wolff-Parkinson-White Syndrome in a Four-Year-Old Girl https://www.ecgguru.com/ecg/wolff-parkinson-white-syndrome-four-year-old-girl <div class="field field-name-field-ecg field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><a href="/ecg/wolff-parkinson-white-syndrome-four-year-old-girl"><img typeof="foaf:Image" src="https://www.ecgguru.com/sites/default/files/WPW100.jpg" width="1400" height="767" alt="" /></a></div></div></div><div class="field field-name-field-ecg-interpretation field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>WPW is one of the "pre-excitation" syndromes caused by an accessory pathway that bypasses the AV node. This pathway is called the Bundle of Kent. This ECG clearly demonstrates the "delta wave" caused by the atrial impulse traveling around the AV node and pre-exciting part of the ventricle. These delta waves are best seen in Leads I and V4 - V6. The delta wave in Lead II is a small notch. A short PR interval is also seen. The accessory pathway can, along with the normal pathway through the AV node, form a circle or circuit, making the heart vulnerable to re-entrant tachycardia. This ECG is from a four-year-old girl who had not been previously diagnosed.</p> </div></div></div> Mon, 19 Dec 2011 18:21:07 +0000 Dawn 140 at https://www.ecgguru.com