The clinical interpretation of electrocardiogram in hypertensive children and adolescents

The validity and usefulness of the ECG criteria of left heart hypertrophy according to Sokolow and Lyon were tested in 54 hypertensive children and adolescents. Among them, there were 9 children with secondary hypertension of known origin, and 45 adolescents with labile juvenile hypertension due to hyperkinetic heart activity. Only in 21 (38%) patients were present positive ECG criteria of hypertrophy. In view of the fact that between 8 and 16 years of age the R and S voltage in left precordial leads in normal adolescents exceeds the voltage limits of these criteria in adults, the validity of criteria is discussed. It is postulated that the investigated criteria lose their validity in the given age group because of the age differences in the ECG patterns. An ECG diagnosis of cardiac hypertrophy can be made only when more than two positive criteria are present together with a clinical evidence of enlarged heart. If only one or two voltage criteria are present, it is advisable to interpret this as an ECG manifestation of left heart systolic overload and to use it only as auxiliary sign for further follow-up of the patient.