2-year old boy presenting with febrile seizure. Interpret the ECG.

TOP 100 ECG QUIZ LITFL 051

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) 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 |

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