ECG Changes in Children With Heart Conditions

This page contains detailed information on ECG changes observed in children with various heart conditions. It is structured to highlight the key ECG features associated with congenital heart defects, cardiomyopathies, and arrhythmias. Each section provides a concise list of diagnostic criteria, making it a valuable resource for identifying and understanding these conditions.

Designed with both students and doctors in mind, this page serves as an excellent tool for quick revision and reference. Whether you are preparing for exams, clinical rotations, or simply need a refresher, the organized layout and clear descriptions ensure that you can efficiently review the essential ECG characteristics relevant to pediatric cardiology.

Atrial Septal Defect (ASD):

  • Right axis deviation (typically between +90° and +180°)
  • rSR' pattern in V1 (incomplete right bundle branch block)
  • Prolonged PR interval (first-degree AV block in some cases)
  • Increased R wave amplitude in V1 and V2

Ventricular Septal Defect (VSD):

  • Left ventricular hypertrophy: Increased R wave amplitude in V5-V6, deep S waves in V1-V2
  • Left atrial enlargement: Notched P wave in lead II with duration >0.08 seconds
  • Q waves in leads I and aVL (in some cases)

Tetralogy of Fallot:

  • Right axis deviation (often >+120°)
  • Right ventricular hypertrophy: Tall R waves in V1, deep S waves in V5-V6
  • T wave inversion in right precordial leads
  • Absent Q waves in left precordial leads

Patent Ductus Arteriosus (PDA):

  • Left ventricular hypertrophy: Increased R wave amplitude in V5-V6, deep S waves in V1-V2
  • Left atrial enlargement: P wave duration >0.08 seconds in lead II, prominent negative P wave component in V1
  • Deep Q waves in leads II, III, and aVF (in some cases)

Transposition of the Great Arteries:

  • Right ventricular hypertrophy: Tall R waves in V1, deep S waves in V5-V6
  • Right axis deviation (typically between +90° and +180°)
  • Absence of normal R wave progression in precordial leads

Hypertrophic Cardiomyopathy:

  • Left ventricular hypertrophy: R wave amplitude in V5 or V6 + S wave amplitude in V1 > 60 mm
  • Deep, narrow Q waves (>3 mm) in lateral (I, aVL, V5-V6) and inferior (II, III, aVF) leads
  • ST segment depression and T wave inversion in lateral and inferior leads
  • Left atrial enlargement: P wave duration >0.08 seconds in lead II, prominent negative P wave component in V1

Dilated Cardiomyopathy:

  • Left atrial enlargement: P wave duration >0.08 seconds in lead II, prominent negative P wave component in V1
  • Left ventricular hypertrophy: Increased R wave amplitude in V5-V6, deep S waves in V1-V2
  • Poor R wave progression in precordial leads
  • Nonspecific ST-T wave abnormalities: ST segment depression, T wave flattening or inversion
  • Widened QRS complex (>0.10 seconds in children)

Supraventricular Tachycardia (SVT):

  • Narrow QRS complexes (<0.08 seconds)
  • Regular, rapid heart rate (usually >220 bpm in infants, >180 bpm in children)
  • Absent P waves or retrograde P waves (inverted P waves after QRS complexes)
  • No variation in R-R intervals

Wolff-Parkinson-White Syndrome:

  • Short PR interval (<0.12 seconds)
  • Delta wave: slurred, slow rise of initial QRS complex
  • Widened QRS complex (>0.10 seconds)
  • Secondary ST segment depression and T wave inversion

Long QT Syndrome:

  • Prolonged QT interval (QTc >0.47 seconds in males, >0.48 seconds in females)
  • T wave abnormalities: notched, biphasic, or alternating T waves
  • Possible T wave alternans (beat-to-beat variation in T wave morphology)
  • Possible torsades de pointes (polymorphic ventricular tachycardia)

Kawasaki Disease:

  • Sinus tachycardia
  • Prolonged PR interval (>0.16 seconds in children)
  • Nonspecific ST segment changes: elevation or depression
  • T wave flattening or inversion in multiple leads
  • Possible low voltage QRS complexes in later stages

Myocarditis:

  • Sinus tachycardia (inappropriate for age)
  • ST segment elevation (usually concave upward) in multiple leads
  • T wave inversions in multiple leads
  • Possible low voltage QRS complexes (<5 mm in limb leads)
  • Possible conduction abnormalities: AV block, bundle branch block

Pericarditis:

  • Widespread concave upward ST segment elevation in most leads except aVR and V1
  • PR segment depression (especially in lead II)
  • Possible low voltage QRS complexes (<5 mm in limb leads) if pericardial effusion present
  • Electrical alternans in case of large pericardial effusion
List of 50 Pediatric Cardiac Conditions and Their ECG Findings
  • Atrial Septal Defect (ASD): Right axis deviation, incomplete RBBB, RVH
  • Ventricular Septal Defect (VSD): Left ventricular hypertrophy, left atrial enlargement
  • Patent Ductus Arteriosus (PDA): Left ventricular hypertrophy, left atrial enlargement
  • Tetralogy of Fallot: Right axis deviation, right ventricular hypertrophy, right atrial enlargement
  • Transposition of the Great Arteries (TGA): Right axis deviation, right ventricular hypertrophy
  • Coarctation of the Aorta: Left ventricular hypertrophy, possible right axis deviation
  • Pulmonary Stenosis: Right axis deviation, right ventricular hypertrophy
  • Aortic Stenosis: Left ventricular hypertrophy, left atrial enlargement
  • Hypoplastic Left Heart Syndrome: Right ventricular hypertrophy, right axis deviation
  • Ebstein's Anomaly: Tall P waves, right bundle branch block, possible WPW syndrome
  • Total Anomalous Pulmonary Venous Return (TAPVR): Right axis deviation, right ventricular hypertrophy
  • Truncus Arteriosus: Biventricular hypertrophy, left axis deviation
  • Tricuspid Atresia: Left axis deviation, left ventricular hypertrophy
  • Double Outlet Right Ventricle (DORV): Right ventricular hypertrophy, right axis deviation
  • Interrupted Aortic Arch: Right ventricular hypertrophy, right axis deviation
  • Pulmonary Atresia: Right axis deviation, right ventricular hypertrophy
  • Single Ventricle: Dominant ventricular hypertrophy, axis deviation
  • Atrioventricular Septal Defect (AVSD): Left axis deviation, bi-atrial enlargement
  • Persistent Truncus Arteriosus: Biventricular hypertrophy, left axis deviation
  • Cor Triatriatum: Right ventricular hypertrophy, right axis deviation
  • Anomalous Left Coronary Artery from Pulmonary Artery (ALCAPA): Deep Q waves in lateral leads, signs of ischemia/infarction
  • Kawasaki Disease: Tachycardia, ST segment changes, possible arrhythmias
  • Dilated Cardiomyopathy: Left ventricular hypertrophy, ST-T wave abnormalities
  • Hypertrophic Cardiomyopathy: Left ventricular hypertrophy, deep Q waves, giant T wave inversion
  • Restrictive Cardiomyopathy: Low voltage QRS, nonspecific ST-T wave changes
  • Myocarditis: Sinus tachycardia, low voltage QRS, ST-T wave changes
  • Long QT Syndrome: Prolonged QT interval, T wave abnormalities
  • Brugada Syndrome: ST segment elevation in V1-V3, right bundle branch block pattern
  • Wolff-Parkinson-White Syndrome: Short PR interval, delta wave, wide QRS complex
  • Catecholaminergic Polymorphic Ventricular Tachycardia: Normal resting ECG, exercise-induced ventricular arrhythmias
  • Sick Sinus Syndrome: Bradycardia, sinoatrial pauses, atrial tachyarrhythmias
  • Complete Heart Block: AV dissociation, bradycardia
  • Supraventricular Tachycardia: Narrow complex tachycardia, often with retrograde P waves
  • Ventricular Tachycardia: Wide complex tachycardia, AV dissociation
  • Pericarditis: Diffuse ST segment elevation, PR segment depression
  • Pericardial Effusion: Low voltage QRS, electrical alternans
  • Cardiac Tamponade: Low voltage QRS, electrical alternans, sinus tachycardia
  • Pulmonary Hypertension: Right axis deviation, right ventricular hypertrophy, right atrial enlargement
  • Endocardial Fibroelastosis: Left ventricular hypertrophy, ST-T wave changes
  • Rheumatic Heart Disease: PR interval prolongation, left atrial enlargement
  • Cardiac Tumors: Varies depending on location, possible arrhythmias or conduction abnormalities
  • Marfan Syndrome: Possible mitral valve prolapse, arrhythmias
  • Duchenne Muscular Dystrophy: Sinus tachycardia, right ventricular hypertrophy, Q waves in lateral leads
  • Friedreich's Ataxia: T wave inversions, left ventricular hypertrophy
  • Noonan Syndrome: Left axis deviation, wide QRS complex
  • Turner Syndrome: Right axis deviation, T wave abnormalities
  • Williams Syndrome: Prolonged QT interval, possible right ventricular hypertrophy
  • Glycogen Storage Diseases: Left ventricular hypertrophy, short PR interval
  • Mitochondrial Disorders: Varies, possible conduction defects or hypertrophy
  • Congenital Long QT Syndrome: Prolonged QT interval, T wave abnormalities
Heart Conditions
Cyanotic Heart Diseases
Tetralogy of Fallot

ECG Findings: Right axis deviation, right ventricular hypertrophy (RVH), and potential right atrial enlargement.

Transposition of the Great Arteries

ECG Findings: Right axis deviation, RVH, and possibly left atrial enlargement.

Tricuspid Atresia

ECG Findings: Left axis deviation, LVH, and atrial enlargement depending on the presence of an atrial septal defect (ASD).

Truncus Arteriosus

ECG Findings: Biventricular hypertrophy, combined right and left ventricular hypertrophy patterns, and often left atrial enlargement.

Total Anomalous Pulmonary Venous Return (TAPVR)

ECG Findings: Right axis deviation, RVH, and right atrial enlargement.

Hypoplastic Left Heart Syndrome

ECG Findings: Right axis deviation, RVH, and possibly low voltage QRS complexes.

Acyanotic Heart Diseases
Ventricular Septal Defect (VSD)

ECG Findings: Left ventricular hypertrophy (LVH), and left atrial enlargement; large defects may also show biventricular hypertrophy.

Atrial Septal Defect (ASD)

ECG Findings: Right axis deviation, RVH, and right atrial enlargement; incomplete right bundle branch block (RBBB).

Patent Ductus Arteriosus (PDA)

ECG Findings: LVH, left atrial enlargement; if pulmonary hypertension is present, may show RVH.

Coarctation of the Aorta

ECG Findings: LVH, left atrial enlargement; if severe, may also show right ventricular hypertrophy.

Aortic Stenosis

ECG Findings: LVH, left atrial enlargement, possible strain pattern in severe cases.

Pulmonary Stenosis

ECG Findings: RVH, right axis deviation, right atrial enlargement in severe cases.

Congenital Heart Block
Complete Heart Block (Third-Degree AV Block)

ECG Findings: Dissociation between P waves and QRS complexes, atrial rate faster than ventricular rate, wide QRS if escape rhythm is from the ventricles.

First-Degree AV Block

ECG Findings: Prolonged PR interval greater than 200 ms, regular rhythm.

Second-Degree AV Block

ECG Findings: Progressive prolongation of the PR interval until a QRS complex is dropped (Mobitz I), or sudden drop of QRS complexes without prior PR prolongation (Mobitz II).

Arrhythmias
Supraventricular Tachycardia (SVT)

ECG Findings: Narrow complex tachycardia, often without discernible P waves; rate usually between 180-250 bpm.

Wolff-Parkinson-White Syndrome (WPW)

ECG Findings: Short PR interval, delta wave (slurred upstroke of the QRS complex), and possible wide QRS complex.

Ventricular Tachycardia (VT)

ECG Findings: Wide QRS complex tachycardia, rate usually greater than 120 bpm, AV dissociation may be present.

Long QT Syndrome

ECG Findings: Prolonged QT interval (QTc greater than 440 ms in males, 460 ms in females), T-wave abnormalities.

Atrial Fibrillation

ECG Findings: Irregularly irregular rhythm, absence of P waves, and irregular R-R intervals.

Premature Atrial Contractions (PACs)

ECG Findings: Early P waves with different morphology than sinus P waves, followed by normal QRS complexes.

Premature Ventricular Contractions (PVCs)

ECG Findings: Wide QRS complexes, not preceded by a P wave, often followed by a compensatory pause.

Cardiomyopathies
Hypertrophic Cardiomyopathy (HCM)

ECG Findings: LVH, deep Q waves in inferior and lateral leads, left atrial enlargement.

Dilated Cardiomyopathy (DCM)

ECG Findings: LVH, left atrial enlargement, wide QRS complexes, possible ventricular arrhythmias.

Restrictive Cardiomyopathy (RCM)

ECG Findings: Low voltage QRS complexes, biatrial enlargement, possible signs of heart block.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

ECG Findings: Epsilon wave in V1, T-wave inversions in right precordial leads (V1-V3), and ventricular arrhythmias.

Other Cardiac Conditions
Pericarditis

ECG Findings: Diffuse ST elevation, PR depression, and possible low voltage QRS complexes.

Myocarditis

ECG Findings: ST-T changes, possible arrhythmias, low voltage QRS complexes.

Endocarditis

ECG Findings: Prolonged PR interval, possible signs of infarction if emboli are present.

Kawasaki Disease

ECG Findings: Non-specific ST-T changes, possible signs of coronary artery aneurysms if involved.

Rheumatic Heart Disease

ECG Findings: Prolonged PR interval, LVH, or RVH depending on valve involvement.

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