
ECG - the neonatal electrocardiograph
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Report the rate, rhythm, conduction, p waves, frontal plane axis, QRS complex.
- Comment on T waves over R chest. Look at QT interval
- Rate = 1500 / number of little squares or
= 300 / number of big squares - Frontal plane QRS axis
Normal Values
Click here to open a larger version of the normal values table
Interpretation
P waves![]() |
Peaked (>3mm) = RA
hypertrophy Broad or biphasic = LA hypertrophy |
|
Right Ventricular Hypertrophy | Pure RV1 >10mm (no
SV1) RV1 >25 (SV1 present) Upright TV1 after 3 days (RV strain) Right axis deviation >+180° |
|
Left Ventricular Hypertrophy | RV6 >17mm in 1st
week (>25mm in 1st month) SV1 >20mm SV1 + RV6 >45mm QV5 or V6 >5mm with tall symmetric T Asymmetric T inversion = LV strain ST depression = LV strain |
|
Biventricular Hypertrophy | Abnormal voltages over R and L
chest leads Prominent mid-precordial voltages |
|
AV Block | 1° 2° Mobitz Type 1 (Wenkebach) 2° Mobitz Type 2 3° |
Prolonged P-R interval Progressive increase in P-R then dropped beat Dropped beats without P-R prolongation Complete heart block |
Tachycardias | Atrial flutter - atrial rate
300-400, and regular saw-tooth pattern of P waves in LI and
LIII. Ventricular rate depends on degree of A-V block. Atrial fibrillation (rare in newborn). Often associated with cardiac abnormalities, especialy if LA enlargement. Atrial tachycardia. AV re-entry tachycardia. WPW: Short P-R paroxysmal tachycardias. Wide QRS with Δ wave re-entry through accessory pathway. AV Nodal re-entry tachycardia Sinus tachycardia |
|
Ventricular Tachycardia | >5 ventricular ectopics in rapid
succession Identify independent atrial activity Direct Indirect Regular, broad complex tachycardia Concordant pattern over chest leads |
(Capture, atrial capture beats with narrow complexes (Fusion, supraventricular beat with ventricular complex) |
Ventricular Fibrillation | ||
Prolonged Q-T | ||
Ectopic Beats | Common: 21-31% of healthy preterm and up to 23% of term infants |
Conditions with Specific ECGs
Preterm Infant
- Shorter QRS duration, shorter PR and QT interval
- Less RV dominance than term infant at birth
AV Canal
- QRS -30 to -90°
- RA enlargement
- Prolonged PR
Ebstein's Anomaly
- QRS low voltage or RBBB or ventricular pre-excitation
- PR prolonged, RA enlargement
Hypoplastic Right Heart
- Variable.
- Absent or diminished RV voltages
Transposition of the Great Arteries
- Often normal
Tricuspid atresia
- RA hypertrophy
- Left axis deviation
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Document Control
- Document type: Clinical Guideline
- Services responsible: Neonatology, Paediatric Cardiology
- Owner: Newborn Services Clinical Practice Committee
- Editor: Sarah Bellhouse
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