In young children, the right ventricle normally extends to the right side of the sternum. To appropriately display right ventricular potentials, ECGs for children in the under five-year age group must include an alternate lead (‘V4R’) on the right side of the chest at a point analogous to the left sided V4.

In utero- high pulmonary pressures and a relatively thick Right Ventricle (RV) -> Initial Right Axis on ECG is normal and resolves after the first 6 months of life

QRS Axis Deviation

• Chest leads in wrong position

   

• Newborns
• RVH secondary to Right ventricular outflow tract obstruction eg: Pulmonary
  Stenosis ,Tetralogy Of Fallot, Noonans (characterized by mildly unusual facial features, short stature, heart defects, bleeding problems, skeletal malformations, and many others)
• RBBB

LAD:

• LBBB
• LVH secondary to LVOTO (Left Ventricular Outflow Tract Obstruction) e.g. Aortic Stenosis, HOCM

Manually calculate QTc – HERE

Normal QTc:

• Infants less than 6 months = < 0.49 seconds.
• Older than 6 months = < 0.44 seconds.

QTc is prolonged in:

• Hypocalcaemia
• Myocarditis
• Long QT syndromes such as Romano-Ward Drugs

QTc is short in:

• Hypercalcaemia
• Congenital short QT syndrome

• The precordial T-wave configuration changes over time
• For the first week of life, T waves are upright throughout the precordial leads.
• After the first week, the T waves become inverted in V1-3 (= the “juvenile T-wave pattern”)
• This T-wave inversion usually remains until ~ age 8; thereafter the T waves become upright in V1-3.
• However, the juvenile T-wave pattern can persist into adolescence and early adulthood (= “persistent juvenile T waves”).

Some ST changes may be normal:

• Limb lead ST depression or elevation of up to 1mm (up to 2mm in the left precordial leads).

• J-point depression: the J point is depressed without sustained ST depression, i.e. upsloping ST depression

• Benign early repolarisation in adolescents: the ST segment is elevated and concave in leads with an upright T wave.

Others are pathological:

• A downward slope of the ST followed by a inverted T.

• A sustained horizontal ST segment depression

   

Pathological ST segment changes are commonly associated with T wave changes and occur in:

• Pericarditis.

• Myocardial ischaemia or infarction.

• Severe ventricular hypertrophy (ventricular strain pattern)