ECG Case 051
2-year old boy presenting with febrile seizure. Interpret the ECG.
Describe and interpret this ECG
ECG ANSWER and INTERPRETATION
This is a normal paediatric ECG, displaying multiple age-appropriate features:
- Heart rate of 110 bpm (normal for age)
- Dominant R waves in V1-3
- Partial RBBB (RSR’ pattern in V1)
- Juvenile T-wave pattern (T wave inversion in V1-3)
CLINICAL PEARLS
Any of the following findings may be normal on the paediatric ECG:
Heart rate and rhythm
- Heart rate >100 beats/min
- Marked sinus arrhythmia
Right-sided predominance
- Rightward QRS axis > +90°
- Dominant R wave in V1
- RSR’ pattern in V1
- T wave inversions in V1-3 (“juvenile T-wave pattern”)
P waves
- Slightly peaked P waves (< 3mm in height is normal if ≤ 6 months)
Intervals
- Short PR interval (< 120ms) and QRS duration (<80ms) due to smaller cardiac size
- Slightly long QTc (≤ 490ms in infants ≤ 6 months)
Pseudo-infarction patterns
- Q waves in the inferior and left precordial leads
Further reading
Related topics
- Normal paediatric ECG
- Paediatric ECG lead placement
- Stepwise assessment of the paediatric ECG
- Common paediatric arrhythmias
- Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course. Understand ECG basics. Medmastery
- Wiesbauer F, Kühn P. ECG Mastery: Blue Belt online course: Become an ECG expert. Medmastery
- Kühn P, Houghton A. ECG Mastery: Black Belt Workshop. Advanced ECG interpretation. Medmastery
- Rawshani A. Clinical ECG Interpretation ECG Waves
- Smith SW. Dr Smith’s ECG blog.
- Wiesbauer F. Little Black Book of ECG Secrets. Medmastery PDF
TOP 100 ECG Series
MBBS FACEM DDU (Emergency) CCPU. Emergency Physician in Melbourne, Australia. Co-Ultrasound Lead for Emergency Medicine at The Alfred Hospital. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor of the LITFL ECG Library.
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |
