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ECG findings after myocardial infarction in children after Kawasaki disease
T Nakanishi1, A Takao, C Kondoh
1Department of Pediatric Cardiology, Heart Institute of Japan, Tokyo.
Insights
Deep Q waves on electrocardiograms (ECGs) can indicate myocardial infarction in children post-Kawasaki disease. Specific Q wave characteristics help diagnose inferior and anterior infarction, aiding early detection and treatment.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Imaging and Diagnostics
- Kawasaki Disease Research
Background:
- Kawasaki disease is a leading cause of acquired heart disease in children.
- Myocardial infarction (MI) is a serious complication following Kawasaki disease.
- Electrocardiography (ECG) is a crucial non-invasive tool for diagnosing cardiac conditions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of standard 12-lead ECG criteria for myocardial infarction in children.
- To determine the sensitivity and specificity of ECG findings for identifying inferior and anterior myocardial infarction.
- To correlate ECG Q wave characteristics with confirmed MI in pediatric patients post-Kawasaki disease.
Main Methods:
- Retrospective analysis of standard 12-lead ECGs from 17 children with MI and 78 controls post-Kawasaki disease.
- Myocardial infarction diagnosis confirmed by clinical examination, coronary angiography, ventriculography, thallium-201 myocardial imaging, or autopsy.
- Assessment of Q wave amplitude and duration in specific ECG leads (II, III, aVF, I, aVL, chest leads).
Main Results:
- Deep Q waves in leads II, III, or aVF (duration ≤0.04s) showed 86% sensitivity and 97% specificity for inferior MI.
- Deep and wide Q waves (duration ≥0.04s) in anterior chest leads had 75% sensitivity and 99% specificity for anterior MI.
- Q waves in lateral leads (I, aVL) were wider than 0.04s in all observed cases of lateral infarction.
Conclusions:
- Standard 12-lead ECGs are valuable for detecting myocardial infarction in children after Kawasaki disease.
- Specific deep Q wave criteria in inferior and anterior leads demonstrate high diagnostic accuracy.
- ECG analysis, particularly Q wave morphology, aids in the early identification of pediatric myocardial infarction.
Abstract:
Standard 12-lead ECGs were evaluated in 17 children with myocardial infarction and 78 children without myocardial infarction after Kawasaki disease; sensitivity and specificity of the ECG infarction criteria were determined. The presence or absence of myocardial infarction was determined from either clinical examination results (coronary angiography, ventriculography, and thallium-201 myocardial imaging) or autopsy findings. Of seven patients with inferior infarction, abnormally deep Q waves in lead II, III, or aVF were observed in six, but the duration was greater than 0.04 second in only one (14%). The sensitivity and specificity of inferior infarction criteria based on Q wave amplitude were 86% and 97%, respectively. Of eight patients with anterior infarction, seven (88%) had abnormally deep and wide (greater than or equal to 0.04 second) Q waves in anterior chest leads. The sensitivity and specificity of the infarction criteria based on the amplitude and duration of the Q wave were 75% and 99%, respectively. Of seven patients with lateral infarction, Q waves were observed in lead I, aVL, or both in four patients, and in all of these patients Q waves were wider than 0.04 second. In two patients with both inferior and anterior infarction, Q waves were observed only in leads II, III, and aVF; in only one patient were the Q waves wider than 0.04 second. Thus deep Q waves in lead II, III, or aVF that are not wider than 0.04 second may indicate inferior infarction in children. Q waves in lead I, aVL, and chest leads associated with anterolateral infarction are in most instances deep and wide.