Pediatric Cardiology Center of Oregon (PCCO) has been at the forefront of medical care for children and adults with congenital heart disease since first opening its doors in 1986. Show
PCCO’s pediatric heart program has pioneered important advances in the treatment of congenital heart disease. Plus, our affiliation with Legacy Emanuel Hospital and the Randall Children’s Hospital means that our patients receive first-rate care in a state-of-the-art building designed and built specifically to promote a healing environment for children. As part of our continuing effort to educate the broader community about our medical services and best practices for treating children with congenital heart disease, we thought we’d take a moment to go over the basics of pediatric ECG lead placement.  Americans may be more familiar with the acronym “EKG” (which derives from the German Elektrokardiogramm), but most medical practitioners use “ECG” (electrocardiogram) for the process of recording the heart’s electrical activity using electrodes. The electrodes are placed at specific points on the patient’s skin in order to detect electrical changes in the heart that may indicate cardiac problems. It’s the placement of the ECG leads (labeled with a V) that we’re focusing on here. (Quick note: At PCCO, we follow adult guidelines for pediatric patients weighing 90 pounds or more. See below for infants, toddlers, and children weighing less than 90 pounds.) ECG Basics
Extra Pediatric Leads for 15 Lead Right side of chest:
Left side of chest:
For infants, toddlers, and children under 90 lbs, measuring rib spaces is not usually possible.
Extra Pediatric Leads for 15 Lead Right side of chest: V3R Midway between V1 and V4R V4R Below the nipple at the midclavicular line Left side of chest: V7 after V6 For all ECGs, limb leads should be placed on the limbs — not the torso. Arm leads should be placed just above the elbows. Leg leads should be placed between the knee and ankle. One final tip: If computer interpretation reads “Right Superior Axis Deviation” or “Northwest Axis,” be sure to check the limb leads. Pediatric Cardiology Center of OregonPCCO operates outreach clinics throughout Oregon and Southwest Washington, so we’re never too far away. Contact Pediatric Cardiology Center of Oregon for more information on our world-class pediatric care and to find a location near you. Image courtesy of Serge Bertasius Photography / FreeDigitalPhotos.net The electrocardiogram remains an important test for the diagnosis and evolution of congenital heart disease, arrhythmias or other heart conditions during childhood. The basic principles of pediatric electrocardiogram are identical to those in adults, but in children, the EKG presents different features, conditioned by the patient's age. In this article we give you all the tools for correct interpretation of a pediatric EKG and its differences with the adult electrocadiogram. How to perform an Electrocardiogram to a child?The electrocardiogram is performed in a child in the same way as adult EKG. 10 electrodes are placed in their usual positions, and should prevent the child from moving during EKG acquisition (this is the hard part). Limb electrodes can be placed on the torso to reduce movement artifacts. In newborns and infants must also make V3R and V4R (right-side leads) for a better study of the right ventricle. When done, it should be reviewed before removing the electrodes, ensuring proper calibration and the absence of artifacts or poorly recorded Leads. Differences between the Pediatric and Adult ElectrocardiogramThe pediatric electrocardiogram has different features, these differences are more pronounced in newborns, and, as the patient grows, are varying through adolescence. Electrocardiogram of a Newborn:In newborns there is a predominance of the right ventricle to the left ventricle due to the fetal circulation. On the EKG trace can be observed:
Electrocardiogram Changes With Age:Heart axis: the QRS axis direction is moving toward normal values (between -30º and 90º). Precordial leads: R wave in lead V1 and S wave in lead V6 are becoming smaller, while S wave in lead V1 and R wave in lead V6 increase their amplitude. Heart rate: as the child grows, heart rate decreases. In the healthy adult it is between 60 and 100 bpm. Length of waves and intervals: The length of the waves and intervals of the electrocardiogram increases with age (wider waves and longer intervals). T wave: T wave is positive in precordial leads in newborns, but after the first week of life becomes negative in leads V1-V3 and persists through adolescence and even, in young adults (juvenile T wave pattern). For a correct analysis of pediatric EKG it is essential to know the age of the patient and also know the normal values of each age. Electrocardiogram from a healthy 2 year old child: Normal Values of Pediatric ElectrocardiogramThe following table shows the normal values for heart rate, heart axis, length of waves and intervals and amplitude of the R waves and S waves in leads V1 and V6 in each pediatric age range.
Non-pathological Changes of Pediatric ElectrocardiogramIn children, is common to find changes in the electrocardiogram which are considered non-pathological disorder. Sinus arrhythmia: changes in heart rate (PP intervals) with breathing. Sinus arrhythmia occurs often in children, adolescents and young adults. Is considered a normal sinus rhythm variation. Wandering atrial pacemaker: sinus P waves alternating with ectopic P waves. It is observed as P waves with different morphologies in the same lead. The PR interval may also be variable. Wandering pacemaker is usually caused by increased vagal tone, rarely causes symptoms or requires treatment. Supraventricular extrasystoles: presence of a narrow premature QRS. It may be preceded by ectopic P wave (atrial origin) or not (node origin). No pathological significance, but may cause symptoms. RSR’ pattern in V1: the incomplete left bundle branch block is also often found in childhood and youth, in patients without heart disease. Although if it is accompanied by heart murmur, an atrial septal defect should be ruled out. First degree AV block and second degree AV block, type I (Wenckebach): may be seen in children with increased vagal tone, no pathological significance (see AV blocks). Early repolarization: concave ST segment elevation with terminal QRS slurring or notching (J wave). It is an EKG pattern most commonly seen in adolescents and young athletes. No pathological significance, although, it has been found to be associated with a modest increased risk of ventricular arrhythmias, in some recent studies (see early repolarization). If you Like it... Share it. Can’t MissWhen performing an EKG on an infant where should the EKG technician place lead V3R?EKG test questions. In which of the following locations should the electrode for lead V2 be placed?Placement of Lead V2
Since you have placed lead V1, you can now put the electrode for lead V2 at the same level to the left side of the sternum (4th intercostal space, left sternal border). You could also follow the same instructions for V1, but again place the lead on the left side of the sternum.
In which of the following locations should an EKG technician place the electrode for lead V7 V8 V9?ekg
In which of the following locations is the electrode for lead v4r placed?The most useful lead is V4R, which is obtained by placing the V4 electrode in the 5th right intercostal space in the mid-clavicular line.
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When performing an EKG on an infant in which of the following locations should the EKG tech place the electrode for lead V3R?
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