oa CME : Your SA Journal of CPD - Pattern recognition in paediatric ECGs : the hidden secrets to clinical diagnosis

Volume 29, Issue 11
  • ISSN : 0256-2170



In general, medical practitioners (and paediatricians in particular) are trained to recognise common patterns of abnormalities in order to derive clues to disease diagnosis. This is typical of most clinical settings, especially in history taking and clinical examination, but also for investigations such as X-rays and common routine blood tests. It is therefore curious that even though there are a limited number of typical ECG commonly found in routine paediatric cardiac examination, ECG interpretation is often viewed with trepidation and the common patterns are not readily recognised. Rather, the practitioner (or student) faced with an ECG blindly runs through the mantra of , ignoring (or not recognising) the blatant abnormalities that in clinical context may supply clues to an immediate cardiac diagnosis. A cyanosed newborn with a left axis has tricuspid atresia until proven otherwise; a 6-year-old boy with weakness and large R waves in lead V1 probably has Duchenne muscular dystrophy; a child with Down syndrome and a left axis has an AV canal defect; a child with a history of syncope and unusual T waves may have long QT syndrome. It is not difficult to recognise, within clinical context, a diagnostic ECG pattern. The technicalities of rate, rhythm and axis remain as important as ever, but may play only secondary roles in the diagnostic value of the ECG.

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