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ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE

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.

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ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE

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  1. ELECTROCARDIOGRAM IN CONGENITAL HEART DISEASE R. TANDON

  2. 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

  3. Investigations are complimentary to each other in helping reach an accurate clinical diagnosis.

  4. ECG is the quickest, safest, least expensive and most widely available cardiac investigative tool.

  5. Electrocardiogram : Utility • Identify cardiac malposition. • Atrial and ventricular hypertrophy - specific dx. - assess severity • Pericard. and myocard. disease. • Electrolyte imbalance. • Atriovent. & intravent conduction abn. • Arrhythmias.

  6. In congenital heart disease interpretation of the ECG is useful only on the patient’s bedside.

  7. CONGENITAL HEART DISEASE ECGCrucial data • Age • Cyanotic or acyanotic • Heart size – x-ray

  8. Electrocardiogram At Birth : RAD (+90 to +120) RVH At 2 to 5 years :- Normal axis (+30 to +75) Normal LV dominance Transitional period (Unstable ECG)

  9. CONGENITAL HEART DISEASE CLASSIFICATION L  R shuntsObstr. lesionsCyanotic pts • Atrial level Right sided With PS • Vent. Level Left sided With PAH • PA level

  10. 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.

  11. CONGENITAL HEART DISEASE L to R Shunts : Atrial level • QRS 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  PAH • Atrial septal defect 1° - right, left, right + left, V.H.

  12. CONGENITAL HEART DISEASE L to R Shunts : Vent. & PA level • Normal 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.

  13. 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.

  14. CONGENITAL 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.

  15. CONGENITAL HEART DISEASE Cyanotic :  QP, No VSD, CE+ (R  L at atrial level) • Pure PS - Severe • Ebsteins anomaly.

  16. 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.

  17. CONGENITAL HEART DISEASE Cyanotic : TOF physiology

  18. CONGENITAL HEART DISEASE Cyanotic : TOF physiology LAD or RAD Equiphasic complexes across. precordium, q may be absent. Single ventricle.

  19. CONGENITAL HEART DISEASE Cyanotic : TGA physiology CE + Congestive cardiac failure + Age - NB

  20. CONGENITAL HEART DISEASE Cyanotic Patients : Eisenmenger Phys.

  21. CONGENITAL HEART DISEASE Cyanotic Patients : Pulm. Ven. Obstru. ‘P’ Pulm, RAD, RVH. • Hypoplastic left heart • TAPVC with PV obstru. (Xray – Diagnostic)

  22. CONGENITAL HEART DISEASE Cyanotic : Miscellaneous (No PS, normal PA pr). RAD RVH - TA PVC. LAD RVH - Single atrium Normal ECG - SVC to LA. Pulm. AV fistula.

  23. SPOT DIAGNOSIS BY ECG • ALCAPA • Ebstein’s anomaly • Ventricular inversion (l-loop) • Situs inversus • Hypertrophic cardiomyopathy

  24. Arrhythmias and conduction defects suggest specific congenital cardiac anomalies

  25. SSS • ASD in Holt Oram synd. • Sinus venosus ASD. • AV canal defects • Ebstein’s anomaly. • Asplenia, polysplenia synd.

  26. Narrow QRS tachycardia • Ebstein’s disease. • Cong. CTGA • LV – RA shunt • AV canal defects • Older pts of TA and ASD 2°.

  27. Wide QRS tachycardia • ALCAPA • Coron. arterio-ven. fistula • Arrhythmogenic RV dysplasia.

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