Role and importance of electrocardiography in pediatric practice The International Student Congress (ISC) May 26-28th 2016 Graz, Austria Role and importance of electrocardiography in pediatric practice Nedim Begić, Edin Begić, Malik Ejubović, Aida Begić, Dženan Jahić, Amir Jahić Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina

INTRODUCTION Electrocardiogram of babies and children is different than electrocardiogram of the normal adults. During the routine interpretation of electrocardiogram we compute the rhythm, frequency, electrical axis and hypertrophy of one of the heart chambers or whole heart.

Rhytm is being characterised based on P wave axis (positive P wave in second standard lead represents sinus rhytm). This is the normal rhythm of the heart (impulse originates within the SA node (physiological)). When the impulse originates somewhere outside SA node we say that it is non sinus rhytm and it can be pathological.

Heart frequency depends on children age and it varies between 55-180/min. Tachycardia is defined as a heart rate greater than the highest value for child age, whilebradycardia represents heart rate less than lowest value for child age.

Electrical axis shows the direction of electrical and anatomical axis of heart. The mean electrical axis tells us the net direction the depolarization or repolarization is heading (domination of some of the heart chambers). Normal mean electrical axis is between -18 and 112 degrees. Right axis deviation is between 112 – 180 degrees (PS, ToF), left axis deviation is between -18 and -90 degrees (DAO, Ao St).

Some of the congenital heart defects have characteristic deviation of the mean electrical axis which can be useful for diagnosis, of course, together with physical examination, X ray, laboratory and ultrasound.

PQ interval is time of duration of depolarization of ventricles. The duration of this interval in children is between 0,10 – 0,20 seconds, and it is in dependence of age and frequency. Shorter PR interval less than 0,10 seonds is a sign of preescitation (WPW syndrom) and longer PR interval represents block.

Heart hypertrophy are being diagnoses based on length and amplitudes of QRS complexes, changes in ST segment and changes of T wave, ratio R and S wave, changes in P wave (length and amplitude). We can find right ventricular hypertrophy (ToF, TVKS, ASD II, PS, PAH), left ventricular hypertrophy (VSD, DAP, COA, AS), combined (biventricular) hypertrophy (AVSD; Tr Art, big VSD).

Pathological changes of ST segment, T and P wave can also be find in pericarditis, miocarditis, heart infarction (Mb. Kawasaki), electrolyte changes, pulmonary arterial hipertension, drug influence.

MATERIAL AND METHODS In 2015th year (01.01.2015 – 31.12.2015), i pediatric ambulances for healthy and ill children, in ambulances of school medicine and ambulance of familiy medicines in Primary health care Breza, BiH, in total 621 ECG was made and interpreted which represents 5,8 % of all examinations.

RESULTS There was higher prevalence of females (59,92%), and most often children were in school period (64,8%).

Most commonly complete ECG was made, rarely only standard ECG, and extremely rarely longer second lead, with or without charge. ECG with extended leads weren’t done (VR1, VR2) (useful in some conditions such as right ventricular hypertrophy, mezocardy, dekstrocardy).

Indications for electrocardiography were: suspected rhythm disorders (48,5%), chest pain (28%), preoperative preparation (20%), antiarrhythmic therapy control (1%), evaluation of heart hypertrophy (0,4%), electrolytes disorders (0,1%), and others (2%).

FINDINGS

CONCLUSION Electrocardiography is basic method and it still remains the of detection and evaluation heart rhythm disorders in children age and follow up and results of treatment of rhythm disorders control of therapy for hearth rhythm disorders, and in diagnostics of congenital heart diseases as well.

This method is also important in chest pain differentiation. CONCLUSION ECG has big importance in everyday preoperative preparations for every surgery/intervention at pediatric age. This method is also important in chest pain differentiation.

CONCLUSION Continuous ECG Holter monitoring has become irreplaceable method in everyday diagnostics and therapy of arrhythmias in children (sovereign diagnostic method (gold standard) of arrhythmias in children).

This method is available, useful, meaningful and economical. CONCLUSION ECG is most commonly used diagnostic method in medicine and routine method in everyday work with children. (first ECG was recorded 1887. year, and first ECG at children was recorded 1908. year by Hatch). It doesn’t loose its value after more than 100 years. This method is available, useful, meaningful and economical.