Chest Pain Clinical Pathway — Emergency Department
ECG Tips
Potentially Concerning ECG Findings in Children with Chest Pain
- Ischemia, Myocarditis or Pericarditis:
- Right or Left Ventricular Hypertrophy:
- Right Ventricular Hypertrophy:
- Upright T wave between 4 days and Puberty in V1
- Tall R V1 (> 20-29 mm) and Deep S V6 (5-20mm)
- qR pattern in V1
- Right axis deviation for age
- Left Ventricular Hypertrophy:
- Tall R V6 (> 25 mm) or Tall R V5 (> 35mm) and deep S V1(> 25mm)
- Q in V6 > 4 mm
- Left axis deviation for age
- Right Ventricular Hypertrophy:
- Prolonged QTc (calculated per Bazett's Formula) greater than or equal to 450 msec 1, 4. Note: Prolonged QTc in of itself rarely is an etiology for chest pain, these children more often present with syncope
- Abnormal Rhythm from child's baseline*
- Including abnormal P wave axis (outside of 0-90 degrees) in setting of tachycardia
- Wide QRS for age including a new bundle branch block*
- Frequent PVCs on a 12 lead ECG or multiform PVCs
*Assuming there is a prior ECG available
References
- Epidemiology and Risk Factors of Pediatric Chest Pain: a Systematic Review
- Management of Pediatric Chest Pain Using a Standardized Assessment and Management Plan
- Effectiveness of Screening for Life-threatening Chest Pain in Children
- Resource Utilization Reduction for Evaluation of Chest Pain in Pediatrics Using a Novel Standardized Clinical Assessment and Management Plan (SCAMP)