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49 Cards in this Set
- Front
- Back
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Voltages and heart beats in kids
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lower voltages
faster heart beat |
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Important for kids EKG
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intervals
atrial enlargement |
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Rhythms in kids
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sinus
subsidary pacemaker tachy(common) brady(common) AV block (rare) |
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Most common arythmia in kids
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sinus arythmia
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Normal sinus rhythm in kids
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P wave before every QRS
QRS following every P Normal P wave axis Nomral PR interval NOT required (it can be super short and still be normal |
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Normal P wave axis
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0-90 degrees
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Abnormal P wave axis indicates
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ectopic pacemaker
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Coronary sinus or "low right atrial" rhythm
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common BENIGN finind, especially in teens
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6 seconds
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30 big boxes
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3 seconds
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15 big boxes
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Rate
1 big box 2 3 4 5 6 |
300 bmp
150 100 75 60 50 |
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Normal HR newborn
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110-150bpm
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NHR 2 yr
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85-125
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NHR 4yr
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75-115
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NHR >6yr
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60-100
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NHR adult
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50-100
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Axis determination
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Leads I and avF
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Situs invertus
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everything is on the wrong side
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RAD and RVH
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normal in neonates
>100 degrees |
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LVH in neonate
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very BAD
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LAD
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<-5 degrees
Q waves in leads I and avL no correlation with LVH |
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LAD associated with
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atrioventricular septal defect
Down syndrome |
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Causes of LAD
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normal variant
AV septal defect permembranous inlet VSD Tricuspid atresia single ventricle double outlet right ventricle noonan syndrome left anterior hemiblock after MI |
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PR interval
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increases with age
decreaes with heart rate |
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Long PR
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first degree AV block
drugs atrial surery (scar tissue) acute rheumatice fever Kawaskie disease |
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Short PR
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WPW
glycogen storage disease (Pompe's) Fabry disease GMI gangliosidosis Friedrich's ataxia Duchenne's muscular dystrophy |
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Normal QRS
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0.04-0.08
> .12 BBB .10-.12 evaluate morphology |
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RSR'
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RBBB
RVH volume overload Duchenne's |
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QT
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Ventricular depol to repol
leads II, V5, V6 |
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QTC
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Normal <.44
can be .45 in adol/adult females can be .49 in newborns to 6 months |
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How QT looks in sudden cardiac death
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long QT and HR increases so does QT
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Short QT
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Digoxin
Hypercalcemia |
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Long QT--acquired
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Metabolic
hypocalcemia hypomagnesemia malnutrition (anoerxia) Drugs la and III antiarrhythmics Phenothiazines TCA CNS trauma Myocardial ischemia myocarditis |
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Long QT--congenital
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Jervell-Lange-Nielsen
AR, deafness Romano-Ward AD, normal hearing |
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Right Atrial enlargement
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P wave >2.5mm in lead II
deep negative deflection in first 0.04 sec in chest leads |
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Left atrial enlargement
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terminal portion of P wave
negative dflection in V1 beyond 0.04sec (biphasic) Duration of negative deflection > or = 0.04 sec total duration >.10 sec |
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Mild RVH
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R' > 15mm (<1yr) or > 10mm (>1yr)
Abnormal RSR' of normal to slightly prolonged duration in right chest leads |
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Moderate RVH
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definite RAD (non-RBBB)
rR' or pure R in right chest leads significant S in left chest leads |
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Severe RVH
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marked RAD
tall pure R wav > 15mm in right chest lead Upright T wave >3-5 days of age Very tall R wave with ST depression and T wave inversion in VI (strain) Deep S wave in V6 |
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LVH
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LAD for age
R in V5, V6 or I, II, III, avF, avL above normal S in VI, V2 above normal Abnormal R/S ratio Deep/wide q wave in V5, V6 Inverted T waves in I, avF (strain) |
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Combined ventricular hypertrophy
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common in kids
voltage for both RVH and LVH large equiphasic QRS complexes in more than 2 limb leads and V2-V5 consider how fat/skinny patient is |
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RBBB
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terminal slurring in QRS
RAD QRS above ULN for age wide/slurred S in I, V5, V6 terminal slurred R' in avR and V1, V2, V3 |
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Causes of RBBB
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ASD/PAPVR
Right vertriculotomy Ebstein's anomaly Coarcation (<6 months) |
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Causes of LBBB
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rare in kids
seen in adults with sichemic and hypertensive hear disease |
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Intraventricular block
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slowing throughout the QRS complex
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Intraventricular block causes
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metabolic disorders (hyperkalemia)
myocardial ischemia (CPR, quinidine toxcitiy) Diffuse myocardial disease |
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WPW
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Short PR for age
delta wave wide QRS for age premature depol of part of the myocardium |
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Lown-Ganong-Levine
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preexcitation syndrome
short PR normal QRS fiber bypass upper AV node but conduct normally |
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Mahaim fiber
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preexcitation syndrome
normal PR long QRS delta wave fiber bypasses His bundle, enters RV myocardium |
