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
TOP 100 ECG Series
MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Adult/Paediatric Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner
Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |