electrocardiogram in congenital heart disease
DESCRIPTION
ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE. R. TANDON. ECG, accurate physical examination and radiology form the tripod on which rests the clinical diagnosis in Ped. Card. Omission of, unfamiliarity with or misinterpretation of any of these three tools spells disaster. Alexander S. Nadas. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/1.jpg)
11
R. TANDON
![Page 2: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/2.jpg)
22
ECG, accurate physical examination and radiology form the tripod on which rests the clinical diagnosis in Ped. Card. Omission of, unfamiliarity with or misinterpretation of any of these three tools spells disaster.
Alexander S. Nadas
![Page 3: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/3.jpg)
33
Investigations are complimentary to each other in helping reach an accurate clinical diagnosis.
![Page 4: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/4.jpg)
44
ECG is the quickest, safest, least expensive and most widely available cardiac investigative tool.
![Page 5: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/5.jpg)
55
Electrocardiogram : Utility Identify cardiac malposition. Atrial and ventricular hypertrophy
- specific dx.- assess severity
Pericard. and myocard. disease. Electrolyte imbalance. Atriovent. & intravent conduction
abn. Arrhythmias.
![Page 6: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/6.jpg)
66
![Page 7: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/7.jpg)
77
In congenital heart disease interpretation of the ECG is useful only on the patient’s bedside.
![Page 8: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/8.jpg)
88
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
ECG Crucial data Age Cyanotic or acyanotic Heart size – x-ray
![Page 9: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/9.jpg)
99
Electrocardiogram
At Birth : RAD (+90 to +120) RVH
At 2 to 5 years :-Normal axis (+30 to +75)Normal LV dominanceTransitional period (Unstable ECG)
![Page 10: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/10.jpg)
1010
CONGENITAL HEART DISEASE
CLASSIFICATION
L R shunts Obstr. lesions Cyanotic pts
• Atrial level Right sided With PS• Vent. Level Left sided With PAH• PA level
![Page 11: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/11.jpg)
1111
CONGENITAL HEART DISEASE
CYANOTIC : Subgroups PS, no VSD, R to L at atrial level PS with VSD (TOF physiology). pulm flow (Transposition physiol.) PA pr , pulm. flow (Eisenmenger
physiol). Pulm. ven. obst. PA pr. normal, No PS, No PAH.
![Page 12: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/12.jpg)
1212
CONGENITAL HEART DISEASE
L to R Shunts : Atrial levelQRS axis-30 to +150 Atrial septal
defect 2°QRS axis-15 to -120 Atrial septal defect
1°Atrial septal defect 2° - rsR1 – V1 - 95%RVH PAHAtrial septal defect 1° - right, left, right
+ left, V.H.
![Page 13: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/13.jpg)
1313
![Page 14: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/14.jpg)
1414
![Page 15: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/15.jpg)
1515
CONGENITAL HEART DISEASE
L to R Shunts : Vent. & PA levelNormal axis.L.V. dominance or LVH.RVH PS or PAH.PDA : Left ventricular hypertrophy
with ST and T changes of ischaemia indicates associated Aortic stenosis or LVEFE.
![Page 16: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/16.jpg)
1616
![Page 17: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/17.jpg)
1717
CONGENITAL HEART DISEASE
Obstructive lesions :-RVH : Right sided lesion (PS)
(Except in newborns and neonates).Left ventricular hypertrophy – left
sided lesion (Aortic stenosis, C of A0)ST and T changes in Coarct. of A0
indicates associated Aortic stenosis or LVEFE.
![Page 18: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/18.jpg)
1818
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
Obstructive lesions :-As a rule severity of RVH or LVH is
consistent with the severity of obstruction.
Presence of ST and T changes.Severe obstr.Myocardial dis.
![Page 19: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/19.jpg)
1919
![Page 20: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/20.jpg)
2020
![Page 21: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/21.jpg)
2121
CONGENITAL HEART DISEASE
Cyanotic : QP, No VSD, CE+ (R L at atrial level)
Pure PS - SevereEbsteins anomaly.
![Page 22: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/22.jpg)
2222
![Page 23: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/23.jpg)
2323
![Page 24: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/24.jpg)
2424
CONGENITAL HEART DISEASE
Cyanotic : TOF physiology (VSD + PS)
Clinical : No CE, S1 normal.S2 single, eject syst.
murmur.X-ray : No cardiomegaly.
Ischaemic lungs. Ao large.
![Page 25: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/25.jpg)
2525
CONGENITAL HEART DISEASE
RAD RVH RAD LVH LAD LVH LAD RVH
TOF RV TA AVC
DORV SV SV SV
TGASV
DORV (Small VSD)
DORV (Rare)
DORV(Rare)
Cyanotic : TOF physiology
![Page 26: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/26.jpg)
2626
![Page 27: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/27.jpg)
2727
![Page 28: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/28.jpg)
2828
![Page 29: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/29.jpg)
2929
CONGENITAL HEART DISEASE
Cyanotic : TOF physiologyLAD or RADEquiphasic complexes across.precordium, q may be absent. Single ventricle.
![Page 30: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/30.jpg)
3030
![Page 31: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/31.jpg)
3131
CONGENITAL HEART DISEASE
RAD RVH
RAD LVH
LAD LVH LAD RVH
TGA RV TA SV
TAPVC SV SV AVC
DORVPTA
- RVAVC
-
SV - - -
Cyanotic : TGA physiologyCE + Congestive cardiac failure + Age - NB
![Page 32: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/32.jpg)
3232
![Page 33: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/33.jpg)
3333
![Page 34: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/34.jpg)
3434
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
Cyanotic Patients : Eisenmenger Phys.
RAD RVH RAD LVH LAD LVH LAD RVH
VSD, PDA, APW
RV TA AVC
TGA Physiol.
SV SV SV
ASD 2° - - -
![Page 35: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/35.jpg)
3535
![Page 36: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/36.jpg)
3636
![Page 37: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/37.jpg)
3737
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
Cyanotic Patients : Pulm. Ven. Obstru.
‘P’ Pulm, RAD, RVH.Hypoplastic left heartTAPVC with PV obstru.
(Xray – Diagnostic)
![Page 38: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/38.jpg)
3838
![Page 39: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/39.jpg)
3939
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
Cyanotic : Miscellaneous(No PS, normal PA pr).RAD RVH - TA PVC.LAD RVH - Single atriumNormal ECG - SVC to LA.
Pulm. AV fistula.
![Page 40: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/40.jpg)
4040
SPOT DIAGNOSIS BY ECG
ALCAPA Ebstein’s anomaly Ventricular inversion (l-loop) Situs inversus Hypertrophic cardiomyopathy
![Page 41: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/41.jpg)
4141
![Page 42: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/42.jpg)
4242
![Page 43: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/43.jpg)
4343
![Page 44: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/44.jpg)
4444
![Page 45: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/45.jpg)
4545
![Page 46: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/46.jpg)
4646
Arrhythmias and conduction defects suggest specific congenital cardiac anomalies
![Page 47: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/47.jpg)
4747
SSS ASD in Holt Oram synd. Sinus venosus ASD. AV canal defects Ebstein’s anomaly. Asplenia, polysplenia synd.
![Page 48: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/48.jpg)
4848
![Page 49: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/49.jpg)
4949
Narrow QRS tachycardia
Ebstein’s disease. Cong. CTGA LV – RA shunt AV canal defects Older pts of TA and ASD 2°.
![Page 50: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/50.jpg)
5050
Wide QRS tachycardia
ALCAPA Coron. arterio-ven. fistula Arrhythmogenic RV dysplasia.
![Page 51: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/51.jpg)
5151
Atrioventricular conduction defects and pre-excitation syndrome Ebstein’s disease. Cong. CTGA
![Page 52: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/52.jpg)
5252
Age : 3 yrs, acyanotic.
Dx. : PDA, No PAHShunt 2:1.
X-ray : No CE, Ao+, MPA +Vasc : N to +.
![Page 53: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/53.jpg)
5353
![Page 54: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/54.jpg)
5454
Age : 2 m, cyanotic
Dx. : Transposition physiology
X-ray : CE ++, Vasc. ++.
![Page 55: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/55.jpg)
5555
![Page 56: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/56.jpg)
5656
Age : 2 yrs, cyanotic
Dx. : Fallots’ physiology
X-ray : No CE, Vasc. , Ao+.
![Page 57: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/57.jpg)
5757
![Page 58: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/58.jpg)
5858
Age : 12 yrs, cyanotic
Dx. : Eisenmenger physiology
X-ray: CE +, Vasc : Prominent hilar vasc.,
Ischaemic periphery.
![Page 59: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/59.jpg)
5959
![Page 60: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/60.jpg)
6060
CONGENITAL HEART DISEASECONGENITAL HEART DISEASE
Electrocardiogram provides diagnostic help only on the bedside of the patient from whom the ECG has been taken.
![Page 61: ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE](https://reader035.vdocuments.site/reader035/viewer/2022062423/56814664550346895db383a2/html5/thumbnails/61.jpg)
6161