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We describe a simplified method for interpreting a pediatric electrocardiogram (EKG). The method uses 4 steps and requires only a few memorized rules, and it can aid health care providers who do not have immediate access to pediatric cardiology services. Most pediatric EKGs are normal. However, both abnormal and normal EKGs should be sent to a pedi...
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Abstract
DIAGNOSIS
Throughout 2010, the pediatric cardiologists led by the Director of the Council of Pediatric Cardiology, Dr. Ana de Dios, gathered together and worked hard to develop the first part of the Consensus that is published today. They had meetings with the Area of Consensus and Rules, which oversaw the work.
Today we are pleased with...
In 2020, a girl aged 5 years presented to the coronavirus assessment centre on a remote Scottish island with symptoms consistent with novel coronavirus 2019 (COVID-19). Her mother was concerned as she had noted the patient to have an irregular pulse. COVID-19 has been shown to cause cardiac arrhythmia, and so after discussion with tertiary paediatr...
Objective
To characterise transesophageal echocardiography practice patterns among paediatric cardiac surgical centres in the United States and Canada.
Methods
A 42-question survey was sent to 80 echocardiography laboratory directors at paediatric cardiology centres with surgical programmes in the United States and Canada. Question domains include...
There have been reports that pediatric cardiology is an increasingly competitive field and that it has become difficult for recent graduates to find employment. In Canada, empirical observations are consistent with these findings, but this has not been formally evaluated. The aim of this study was to survey pediatric cardiologists (PCs) on their pe...
Citations
... Axis deviation in the frontal plane was determined using triaxial system of bipolar extremity lead. [14] The extracted data about demographic and clinical signs, side and size of pneumothorax, ECG and echocardiography findings were compared. ...
Primary spontaneous pneumothorax (PSP) commonly occurs in adolescents. PSP symptoms can mimic cardiac event. We aimed to examine electrocardiography (ECG) changes that accompanied PSP in relation to side and size of pneumothorax.
A retrospectively reviewed 57 adolescents presented with PSP and underwent a cardiac evaluation.
Overall, 49 patients (86%) were male, median age of 16 years. Of these, 1 patient had a known mitral valve prolapse. In 56 patients the initial episode of PSP was unilateral (16 left sided and 40 right sided), and 1 was bilateral. The main initial symptom was chest pain or dyspnea and chest pain 66.6% and 33.3% respectively. Small pneumothorax was right and left sided in 1and 8 patients respectively, medium right (n = 8) medium left (n = 22), large right (n = 7) and large left (n = 10). One additional patient had medium bilateral pneumothorax. ECG findings were abnormal in 12 patients (21%) and included ST elevation in 5 patients, inverted T wave in 2 patients, incomplete right bundle branch block in 2 patients, poor R wave progression, left axis deviation and low QRS voltage in 1 patient each. Only 2 patients had abnormal echocardiography findings, MPV (n = 1) and minimal mitral and tricuspid regurgitation (n = 1). Serum troponin-T levels were normal in all patients.
ECG changes were found in 21% among pediatric patients with PSP. No correlation was observed between ECG changes and side/size of pneumothorax. It is important to rule out pneumothorax among children presented with chest pain, dyspnea and ECG changes.
... Fetal ART exposure may impair myocardial growth and improve depressed LV function 17 . This means that the multi-agent HIV therapies that help sustain life may also directly increase the risk of cardiovascular events and accelerated atherosclerosis 18,19 . ...
Background:
Cardiovascular abnormalities are not much reported among human immunodeficiency virus (HIV) infected children especially in Africa where there is high HIV disease. In addition, the use of highly active antiretroviral therapy (HAART) in such children may have a protective effect on the cardiovascular system.
Methods:
Cross-sectional study of randomly selected eighty HIV infected and 80 aged matched non- HIV-infected children were used. HIV-infected children were on HAART for more than 5years and had steadily received the treatment for 6 months prior to the time of the tests. Heights and weights were measured and body mass index calculated. Cardiac indices evaluated were heart rate (HR), PR interval, QRS duration, QT/QTC Interval, P/QRS/T Axis, RV5/SV1 voltage and RV5+SV1 voltage.
Results:
The average heart rate was significantly higher among HIV infected children on HAART than their non-infected counterparts (P= 0.019). At 0.05 significance level, their PR interval was significantly higher than those in the control group (P=0.050). The average QRS duration result also showed a significant difference between that of test and control subjects (P = 0.022).
Conclusion:
The HAART usage possibly improved the cardiovascular functioning in the infected children but the protective effects diminish with increase age and longer exposure.
... This is because QRS widening is defined as 0.09 seconds or more in patients older than 5 years. The normal value of the QT interval in pediatric ECG is 0.44 seconds or less [6]. The hemodynamic parameters included blood pressure, heart rate, and respiratory rate. ...
... Clinically significant QRS widening in children under 5 years is usually 2 small boxes or more (0.08 seconds or 80 msec). For patients older than 5 years, the QRS widening is defined as 0.09 seconds or more [6]. In infants and young children under 2 years, a PR interval of 0.16 seconds (≥160 msec or 4 small boxes) is associated with AV block [6]. ...
... For patients older than 5 years, the QRS widening is defined as 0.09 seconds or more [6]. In infants and young children under 2 years, a PR interval of 0.16 seconds (≥160 msec or 4 small boxes) is associated with AV block [6]. The normal value of the QT interval in pediatric ECG is 0.44 seconds or less [6]. ...
Purpose
Local anesthetic agents such as bupivacaine and lidocaine are commonly used after surgery for pain control. The aim of this prospective study was to evaluate the safety of a mixture of bupivacaine and lidocaine in children who underwent urologic inguinal and scrotal surgery.
Materials and Methods
Fifty-five patients who underwent pediatric urologic outpatient surgeries, were prospectively enrolled in this study. The patients were divided into three groups according to age (group I: under 2 years, group II: between 3−4 years, and group III: 5 years and above). Patients were further sub-divided into unilateral and bilateral groups. All patients were injected with a mixture of 0.5% bupivacaine and 2% lidocaine (2:1 volume ratio) at the surgical site, just before the surgery ended. Hemodynamic and electrocardiographic parameters were measured before local anesthesia, 30 minutes after administration of local anesthesia, and 60 minutes after administration.
Results
The patients' mean age was 40.5±39.9 months. All patients had normal hemodynamic and electrocardiographic parameters before local anesthesia, after 30 minutes, and after 60 minutes. Also, results of all intervals were within normal values, when analyzed by age and laterality. No mixture related adverse events (nausea, vomiting, pruritus, sedation, respiratory depression) or those related to electrocardiographic parameters (arrhythmias and asystole) were reported in any patients.
Conclusions
A mixture of bupivacaine and lidocaine can be safely used in children undergoing urologic inguinal and scrotal surgery. An appropriate dose has no clinically significant hemodynamic or cardiac changes and adverse effects.
Congenital heart disease (CHD) is the most common birth defect affecting approximately 1% of live births. Although CHD is the leading cause of neonatal mortality, advances over the last several decades including significant contributions related to anesthesia care, now allow for survival of most affected infants. The wide spectrum of congenital cardiovascular anomalies and the various types of acquired heart disease in the pediatric age group presents a challenge to the clinician who does not specialize in the care of these children. Even for those with a focus or interest in cardiovascular disease, the range of structural defects, myocardial disorders, and other conditions, and the varied associated hemodynamic perturbations can be overwhelming. The ability to provide optimal perioperative care to affected children heavily relies on a clear understanding of the basic pathophysiology of the congenital anomalies and acquired diseases, familiarity with the commonly used diagnostic modalities in cardiology and their clinical applications, and medical and surgical treatment options available to affected individuals. In this chapter, we present essential concepts in cardiology to enhance the overall knowledge of the practicing anesthesiologist in pediatric cardiovascular disease.
Electrocardiograms may be used to screen for cardiovascular disease (CVD) in children. Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood. The T-wave is generated during ventricular repolarization. T-waves on an electrocardiogram typically undergo maturational changes throughout childhood and adolescence. A pediatric practitioner's ability to understand these changes is required to understand abnormal T-waves and recognize potentially life-threatening types of CVD. This review article uses a series of illustrative cases to highlight CVD associated with T-wave abnormalities in childhood. [Pediatr Ann. 2018;47(3):e106-e111.].
