Osnove elektrokardiograma u djece

master's thesis

• Title (english): Basics of electrocardiogram in children
• Author: Sara Fares
• Mentor: Daniel Dilber (mentor)
• Committee member: Ruža Grizelj (predsjednik povjerenstva)
• Committee member: Marija Jelušić (član povjerenstva)
• Committee member: Daniel Dilber (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Pediatrics); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Elektrokardiografija je jednostavna, neinvazivna i jeftina dijagnostička pretraga čiji je rezultat elektrokardiogram - grafički prikaz električne aktivnosti srca. U pedijatrijskoj su populaciji indikacije za elektrokardiografski pregled poremećaji ritma, hipertrofija klijetki ili pretklijetki, bolesti miokarda i perikarda, bolovi u prsima i elektrolitski poremećaji. Elektrokardiogrami se u djece snimaju pomoću odvoda takozvanog standardnog programa kojeg čini šest odvoda s ekstremiteta i šest prekordijalnih odvoda. U novorođenčadi i dojenčadi od pomoći su dodatni desni prekordijalni odvodi, V3R i V4R. Osnovna načela interpretacije elektrokardiograma jednaka su u djece i odraslih, ali se osobitosti normalnog nalaza razlikuju. Postupne promijene anatomije i fiziologije srca koje se odvijaju od trenutka rođenja do adolescencije odražavaju se u elektrokardiogramu prvenstveno promjenama morfologije QRS kompleksa i T-vala. Prenatalno su sistemska i plućna vaskularna rezistencija gotovo jednake a masa desne klijetke dominira nad masom lijeve. Po rođenju je normalan nalaz devijacije električne osi udesno, R/S omjer veći od 1 i pozitivni T-valovi u desnim prekordijalnim odvodima. Postnatalni porast sistemske vaskularne rezistencije rezultira postupnim zadebljanjem miokarda lijeve klijetke zbog čega se mijenjaju odnosi električnih sila desne i lijeve klijetke tako da do četvrte godine života dječji elektrokardiogram nalikuje onom mlade odrasle osobe. Točna interpretacija pedijatrijskog elektrokardiograma je zahtjevna i iziskuje poznavanje specifičnih elektrokardiografskih promjena ovisnih o dobi. Od velike su nam pomoći opsežne studije provedene s ciljem određivanja normalnih vrijednosti parametara elektrokardiograma u djece. Neke od najpoznatijih su studija Davignona i suradnika objavljena 1980. godine u koju je bilo uključeno 2141 zdravo dijete u dobi od 0 do 16 godina te studija Rijnbeeka i suradnika (2001.) koja je provedena u Nizozemskoj na uzorku od 1912 zdrave djece starosti od 11 dana do 16 godina.

Abstract (english)

Electrocardiography is a simple, non-invasive and inexpensive diagnostic procedure which produces an electrocardiogram – a recording of the electrical activity of the heart. Indications for an electrocardiographic testing in pediatric population are heart rhythm disturbances, atrial or ventricular hypertrophy, myocardial or pericardial diseases, chest pain and electrolyte disturbances, which can all be noticed in the standard electrocardiogram consisting of six limb leads and six precordial leads. The additional right precordial leads V3R and V4R are of help in infants and children. The basic principles of interpretation of the electrocardiogram in children are identical to those in adults, but the characteristics of a normal finding differ. Progressive changes in anatomy and physiology of the heart which take place between birth and adolescence are mainly presented on the electrocardiogram as QRS and T-wave changes. Vascular resistance in the pulmonary and systemic circulations is prenatally nearly equal and right ventricle is larger than the left. During the first days of life, right axis deviation, R/S ration greater than 1, and upright T-waves in the right precordial leads are the norm. After birth, systemic vascular resistance rises causing thickening of the left ventricle. This changes the electrical relations between the left and right ventricle. By the age of four the pediatric electrocardiogram resembles the electrocardiogram of a young adult. Correct interpretation of the pediatric electrocardiogram is therefore potentially difficult and detailed knowledge of these age dependent changes is important. Large studies conducted with the aim of determining normal values of electrocardiographic parameters are of great help. Some of the acknowledged ones are Davignon et al's study published in 1980 which included 2141 healthy children aged 0 – 16 years and Rijnbeek et al's study published in 2001 which was conducted in Netherlands and included 1912 healthy children aged 11 days to 16 years.

• Keywords: elektrokardiogram; djeca; pedijatrija
• Keywords (english): electrocardiogram; children; pediatrics
• Language: croatian
• URN:NBN: urn:nbn:hr:105:920838
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2020-02-10 15:24:15