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[Deep Q waves in the ECG of children--an electro-, vector- and echocardiographic study]
Insights
Deep Q-waves in children, found in 1.26% of cases, are often linked to left ventricular volume overload or left axis deviation, not myocardial infarction. Further investigation is recommended for accurate diagnosis.
Area of Science:
- Pediatric Cardiology
- Electrocardiography
- Echocardiography
Context:
- Deep Q-waves (≥0.4 mV) in consecutive ECGs were identified in 1.26% of 9557 children.
- These findings were further evaluated using echocardiography and vectorcardiography.
- The study aimed to understand the prevalence and causes of deep Q-waves in pediatric populations.
Purpose:
- To investigate the association between deep Q-waves on electrocardiograms (ECGs) and cardiac conditions in children.
- To differentiate between pathological and physiological causes of deep Q-waves.
- To determine the most frequent underlying heart diseases and cardiac abnormalities associated with deep Q-waves in pediatric patients.
Summary:
- Deep Q-waves were observed in 120 children, with 70 undergoing further cardiac assessments.
- The most common causes identified were left ventricular volume overload (35%) and left axis deviation (33.3%).
- Congenital heart defects such as ventricular septal defect (30%) and endocardial cushion defect (23.3%) were also significant findings, while myocardial infarction and septal hypertrophy were rare.
Impact:
- This research highlights that deep Q-waves in children are frequently associated with conditions other than myocardial infarction.
- Findings emphasize the importance of comprehensive cardiac evaluation, including echocardiography and vectorcardiography, for children presenting with deep Q-waves.
- The study provides valuable data for pediatricians and cardiologists in diagnosing and managing pediatric cardiac conditions indicated by ECG abnormalities.
Abstract:
Out of 9557 children we found 120 children (1,26%), who showed deep Q-waves of greater than or equal to 0.4 mV in 3 consecutive ECG's at least in one of the leads I, aVL, V4, V5 and V6. 70 children were investigated additionally by echocardiography, 45 by vectorcardiography according to Frank. Echocardiography revealed an increased septal thickness in 5 patients, a borderline thickness in 8, an increased septal/posterior wall ratio in 4. In the vectorcardiogram 51,1% of the patients had no Q-waves in lead y, mostly in combination with deep Q-waves in a VL or left axis deviation. Q-waves in lead y were combined with Q-waves in V 5/6. The determination of the main axis coincided in 80% of ECG and VCG. Looking for the various heart diseases, 30% of the children with Q-waves had a ventricular septal defect, 23,3% an endocardial cushion defect, 10,8% a patent ductus arteriosus, 3,3% a bradycardia, 2,5% a Bland-White-Garland syndrome and 1,6% a hypertrophic cardiomyopathy. 17,5% of the children had an innocent heart murmur, 5,8% no cardiac symptoms. Other diseases were found in 5%. The most frequent cause of Q-waves in children were volume-overload of the left ventricle (35%) and left axis deviation (33,3%), whereas myocardial infarction and septal hypertrophy (3,3 and 4,1%) were of minor importance. In healthy children (23,3%) we could not find any pathomechanism.