pediatric ecg learning with quiz
DESCRIPTION
Elegant ppt on basics of pediatric ecg with an interesting quizTRANSCRIPT
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DR KIRAN VS
NARAYANA HRUDAYALAYA
BANGALORE
PEDIATRIC ECG IS SIMPLE!
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WHY ME?
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Conduction systemLeads and wavesHow to report?Why ECG alone is useless?How to diagnose with help of ECG?How to evaluate arrhythmias?Answer to win!Conclusion!!
WHAT IS THERE?
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CHEST LEADS PLACEMENT
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NORMAL ECG
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Standardization: 10 mm high so that 10 mm = 1 mV.
Paper speed is correct.Heart rate: 1500/SMALL squaresIntervals: PR and QT intervals, width of the
QRS complexes.QRS axis: L1 and aVF
BASIC BEGINNING
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How to analyse?P: there or not? RatePP: Regular or not?PR: normal or short?QRS: Follows P? RateQRS: narrow or wide?RR: Regular or not?ST: Normal or not?QT: Normal or long?Put them together
Normal Sinus Rhythm
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HOW TO REPORT ECG: WRITE AND PRACTICE!!
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AXIS DETERMINATION
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INSTANT AXIS!
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ATRIAL ENLARGEMENT
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NEVER diagnose only on ECG!ECG
Clinical data
ECG
Diagnosis Prize!!
QUIZ WITH PRIZES!
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RATE, RHYTHM, AXIS, FORCES
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4-mo old boyCyanotic, SO2 80%No spellsESM LUSBYour diagnosis:
CLINICAL DATA
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ANSWER?
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Sinus tachycardia, LAD, LV forces: TRICUSPID ATRESIA
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INTERPRET THE ECG: NO DIAGNOSIS!
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14-year old girlAsymptomatic nowIntermittent palpitations, no syncopeSO2: 94%Split S2, multiple heart sounds, no murmursDiagnosis?
CLINICAL DATA
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ANSWER?
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Sinus, Tall P, splintered QRS: Ebstein anomaly
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READ THE ECG
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6-year old boyAsymptomaticSO2: 98%RV apexNo clickS2 spilt not well appreciatedESM LUSBYour diagnosis in light of ECG?
CLINICAL DATA
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DIAGNOSIS?
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Sinus, RAD, RV Forces: SEVERE PULMONIC STENOSIS
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READ THE ECG
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7-day old girlTachypneoa with recessionsSO2 88% Split S2ESM LUSBYour diagnosis
CLINICAL DATA
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YOUR DIAGNOSIS?
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Sinus tachycardia, RAD, rsR’ in V1, V2, RV forces: TAPVC
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INTERPRET THE ECG: NO DIAGNOSIS
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1-year oldCyanoticSO2: 78%ClubbingS2 singleESM LUSBYour diagnosis
CLINICAL DATA
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YOUR DIAGNOSIS
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Sinus, RAD, RV forces, Early transition: TOF
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INTERPRET THE ECG (CAN NEGLECT THE POINTERS)
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3-month oldSevere LV dysfunctionPulmonary venous congestionCTR 70%LV EF 15%Your diagnosis?
CLINICAL DATA
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YOUR DIAGNOSIS? (CAN CONSIDER POINTERS!)
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Sinus, LAD, Deep Q in lat leads, ST down: ALCAPA
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READ ONLY THE ECG
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3-year old boyFailure to thriveDOES2 splitPSM at apexESM LUSBYour diagnosis?
CLINICAL DATA
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YOUR DIAGNOSIS?
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Sinus tachycrdia, LAD, Long PR, rsR’ in V1, V2, BV Forces: Primum defect with MR
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ONLY THE ECG FINDINGS
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NewbornSevere cyanosisLV apexS2 singleNo precordial murmurContinuous murmur at LUSBYour diagnosis
CLINICAL DATA
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YOUR DIAGNOSIS?
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Sinus tachycardia, RAD, RAE, BV forces: pulmonary atresia with intact IVS, ASD
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ONLY THE ECG FINDINGS
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1-day old boyTachypneoaFeeble pulsesNo R-F delayFeatures of shockRV apexYour diagnosis
CLINICAL DATA
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YOUR DIAGNOSIS
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Sinus tachycardia, RAD, RAE, RV forces, poor R progression: HLHS
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ONLY ECG FINDINGS
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18-year old boyExertional breathlessnessBaseline SO2: 88%, drops to 80% with
minimal effortRV apexLoud S2Your diagnosis
CLINICAL DATA
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YOUR DIAGNOSIS
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Sinus tachycardia, Sup axis, RAE, RV forces with strain: Eisenmengerization
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ONLY ECG FINDINGS
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8-year old girlHad cardiac surgeryAdditional procedure after 3 weeksAsymptomatic nowYour diagnosis?
CLINICAL DATA
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YOUR DIAGNOSIS
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AV dissociation, Sharp artefacts before each QRS, Sup axis, LBBB pattern: VVI Pacemaker with lead in RV
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QTc INTERVAL & LQTS
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Are there normal P waves present?Are the QRS complexes wide or narrow?What is the relationship between the P waves
and QRS complexes?Is the rhythm regular or irregular?
4Qs OF RHYTHM
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ECG per-se is uselessAlways with clinical scenario“Treat the pt; not the ECG” is clichéTreat pt till ECG is OK!Get a good 12-lead ECG with Rhythm strip for
atleast 15 secondsGood luck with ECGs
REMEMBER
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Arrhythmia ECGs need analysis “It looks like....?!” : rarely correctMore it looks normal, more it is likely to be
normal!Analysis of arrhythmia is more important than
giving it a named diagnosisNormal ECG is the most important one to learnTRY, PRACTICE, FAIL, RELEARN – ITS GOOD!!
That’s it!!
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Hell is empty and all the devils are here. -- Wm. Shakespeare, "The Tempest"