III III

ทำไมเราต้องเรียน “Pediatric ECG”? Arrhythmia diagnosis and management Provides clues for the diagnosis of CHD Indicative of other associated problems May identify some discrepancies of the diagnosis prompting further testing or a more careful review of the existing data

Characteristics for evaluating of ECG

Normal ECG

0.04 seconds

0.20 seconds

Standardize

q-wave R-wave

R-R interval p-p interval

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1**-3 to to to +2-4 to +3-2 to +2

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1**-3 to +4-6 to -1-6 to +2-4 to +3-2 to +2

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1**-3 to +4-6 to -1-6 to +2-4 to +3-2 to +2

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1**-3 to +4-6 to -1-6 to +2-4 to +3-2 to +2

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1**-3 to +4-6 to -1-6 to +2-4 to +3-2 to +2

0-7 days1wk – 1m1 m-6m6m-1yr1yr-5yr5-10yr10-15yr>15yr Heart rate P-R interval QRS duration QRS axis QRS V1 Q 0 R S QRS V5 Q R S QRS V6 Q R S Maximum QTc T wave V1** -3 to to to +2-4 to +3-2 to +2

I V1V1

Right Ventricular Hypertrophy (RVH) R-wave in the right chest leads > 98 percentile for age S-wave in the left chest leads > 98 percentile for age Abnormal R/S ratio in the right chest leads qR pattern in the right chest leads rsR or rR pattern in the right chest leads Abnormal t-wave direction in the right chest leads Right axis deviation

Left Ventricular Hypertrophy (LVH) R-wave in the left chest leads > 98 percentile for age S-wave in the right chest leads > 98 percentile for age Abnormal R/S ratio in the left chest leads Deep Q in the left chest leads Abnormal t-wave direction in the left chest leads Left axis deviation

Combined Ventricular Hypertrophy (CVH) Signs of LVH + RVH R+S-wave amplitude in V2 to V5 > 60 mm

Quiz 1 ให้อ่าน ECG นี้

Quiz 2 ทารกอายุ 1 วัน ฟังได้ systolic murmur เบาๆ ตรวจไม่พบความผิดปกติอื่นใด

Quiz 3 เด็กอายุ 1 เดือน เหนื่อยหอบ เลี้ยงไม่โต หัวใจมี hyperactive precordium ฟังได้ systolic murmur ตับโต

Quiz 4 เด็กอายุ 5 ปี พัฒนาการช้า มีปอดอักเสบมานอนโรงพยาบาล ลักษณะเป็น Mongoloid face, hypotonia Chest x-ray พบว่าหัวใจโต

Quiz 5 เด็กอายุ 7 ปี ใจสั่นมา 1 ชั่วโมงก่อน ตอนมาหายแล้ว ตรวจร่างกายไม่พบความผิดปกติใดๆ