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PACs are commonly seen in infants and disappear with increasing age. Premature P wave followed by wide QRS complex (conducted PAC with aberrancy i.e.Premature P wave not followed by a QRS complex (nonconducted PAC).Premature P wave followed by a narrow QRS complex (conducted PAC) (Figure).On the EKG, PACs may appear in one of three forms: PACs represent origination of atrial electrical activity outside the SA node. Sinus tachycardia may be a physiologic response to exercise, anxiety, fever, hypovolemia, hypoxemia or hyperthyroidism.įigure demonstrating an EKG with sinus tachycardia (presence of P waves) Premature atrial complexes (PACs) The heart rate depends on patient age and may reach up to 220 beat/min in neonates. Sinus tachycardia is characterized by narrow fast QRS complexes that are preceded by normal P waves (Figure). This condition may be seen in infants born to mothers with systemic lupus erythematosus (SLE).įigure demonstrating an EKG with third degree AV block A pacemaker placement is warranted in symptomatic patients (Figure). The ventricular rate is significantly slower than the atrial rate. Implantation of a pacemaker may be considered in symptomatic patients.įigure demonstrating an EKG with Mobitz type II second degree AV block Third degree AV blockĬomplete AV block represents complete atrioventricular dissociation with no correlation between the atrial and ventricular electrical activity. It is more serious as it may progress to a complete AV block. Mobitz type II is sudden loss of AV conduction (two or more P waves before QRS complexes). This may be seen in the presence of increased vagal tone, in trained athletes and during sleep (Figure).įigure demonstrating an EKG with Mobitz type I second degree AV block

This is due to impaired conduction through the AV node and is usually benign. Mobitz type I (Wenckebach) is gradual prolongation of the PR interval until there is a complete block (a P wave not followed by a QRS complex). This is secondary to an intermittent failure of conduction through the AV node so that some P waves are not followed by QRS complexes. First degree A-V block could be one of the cardiac manifestations of rheumatic fever (Figure).įigure demonstrating an EKG with first degree AV block It is usually reversible and does not require any treatment. This indicates prolongation of the PR interval more than 95 th percentile for age and heart rate and is due to impairment in the AV node conduction caused by increased vagal tone, AV nodal ischemia or drugs such as digoxin and beta-blockers. Atrioventricular Block First degree AV block In symptomatic bradycardia, the underlying cause should be treated and a pacemaker placement may be considered if there is no response to medical therapy. Pathological sinus bradycardia is usually secondary to an underlying condition such as hypothyroidism or medications such as beta-blockers.Īsymptomatic physiologic sinus bradycardia requires no treatment. Trained athletes may normally have sinus bradycardia due to increased vagal tone. The normal range of heart rate depends on the age of the individual, ranging from 120-160 beat/min in the newborn to 60-80 beat/min in the adult. Arrhythmias may occur in children with normal hearts and/or may be associated with CHD, medications or electrolyte disturbances. Arrhythmias result from abnormal impulse formation, abnormal impulse conduction, or both.

Pulmonary Atresia with Intact Ventricular Septum (PA-IVS).Clinical presentation, EKG and, imaging.Total Anomalous Pulmonary Venous Connection (TAPVC).Corrected Transposition of the Great Arteries (L-TGA).Complete Transposition of the Great Arteries (D-TGA).Systolic Murmur Grades based on the intensity of the murmur.