Right axis deviation in children and adolescents

  Juvenile T pattern (negative T waves in leads V1 to V3, in ages under 16)

  Persistent juvenile T pattern

  Early Repolarization (ER) in mid precordial leads

  Sinus arrhythmia

  Loss of R progression in precordial (chest) leads

  Low voltage in obese subjects

  High voltage in lean subjects

  Sinus bradycardia in trained athletes

  Isolated Q wave in lead III

  Right bundle branch block pattern, RSr' pattern in lead C1 (V1)

  Isolated T wave negativity in lead III

  Negative T wave in lead C1 (V1)

  QS pattern in lead C1 (V1)

  Q wave in lead aVL (in vertical hearts)

  Q waves in inferior and left lateral leads in children




ECG 1. The presence of RSr' pattern in C1 is not always abnormal. The ECG above, belongs to a patient with normal coronary
arteries.

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ECG 2. Early repolarization observed in a 39 years old, apparently healthy male. Early repolarization is generally observed in
leads C3 and C4. The two aspects of ST segment elevation in early repolarization differs from the ST segment elevation in
acute myocardial infarction. The J point is elevated and the ST segment is upwardly concave (smiley face) .
(J point is the point where the end of S wave meets the ST segment).

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ECG 3. The ECG above, belongs to a 50 years old healthy woman with normal coronary arteries. Negative T waves observed in
leads C1-C4 denote to persistent juvenile T pattern.

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ECG 4. Negative T waves in leads C1-C3 of a 10 years old healthy child: juvenile T pattern. Negative T waves are asymmetric.

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ECG 5. The above ECG suggests as diagnosis of inferior wall myocardial infarction at first glance. Although there is a Q wave
in lead III, there is also a small initial positive deflection of the QRS complex in lead aVF: initial R wave . Therefore there is no
q or Q wave in lead aVF. This subject has normal coronary arteries. Observation of q or Q wave only in lead III is usually a
normal variant.

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ECG 6. There is a large Q wave in lead III of the ECG above. Leads II and aVF lack q or Q waves. Lead aVF has initial R wave .
This patient has normal coronary arteries but no history of old inferior wall myocardial infarction.
Observation of q or Q wave only in lead III is usually a normal variant.
The fifth beat from the left is a ventricular premature systole.

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ECG 7. The above ECG belongs to a 14 years old, well-trained, healthy athlete. The QRS axis is about +100 degrees.
In children younger than 16 years of age, the QRS axis up to +120 degrees is accepted as normal.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 8. The ECG above belongs to a 63 years-old woman with normal coronary arteries.
Isolated T wave negativity in lead III may be a normal finding.

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ECG 9. The ECG above belongs to an apparently healthy 13 years-old boy with no cardiac disease.
Observation of rSr' pattern in lead C1 (V1) is accepted as a normal variant.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 10. The ECG above belongs to an apparently healthy 11 years-old boy with no cardiac disease.
Observation of RSR' pattern in lead C1 (V1) is accepted as a normal variant.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 11. The ECG above belongs to a 1 year-old boy with no apparent heart disease. His echocardiogram was also normal.
Observation of Q waves in inferior and lateral leads at such an early age is generally accepted as a normal variant.
Such normal variant Q waves usually have a width < 20 msec (< half a small square).

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 12. The ECG above belongs to an apparently healthy, 8 years-old lean boy.
The ECGs of thin children with a low body mass index may show increased voltage as a normal variant.
In the above ECG, the narrow q waves in leads II, III and aVF are normal variants.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 13. The ECG above belongs to an apparently healthy one year-old baby. His echocardiogram is normal.
Incomplete right bundle branch block may be seen as a normal variant in apparently healthy children.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 14. The ECG above belongs to an apparently healthy, 11 years-old lean boy. His echocardiogram is normal.
The ECG of a lean person with low body mass index may show increased voltage as a normal variant.
In the above ECG, the narrow q waves in leads II, III and aVF are normal variants.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 15. The ECG above belongs to an apparently healthy, 7 years-old boy.
His echocardiogram is normal.
The narrow q waves in leads II, III, aVF, V5 and V6 are benign.

Pediatric cardiologist Dr. Mahmut Gokdemir has donated the above ECG to our website.

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ECG 16. The compact ECG above belongs to an apparently healthy, 18 years-old lean male.
His echocardiogram is normal.
The narrow q waves in leads II, III, aVF, V5 and V6 are benign.




ECG 17. The ECG above belongs to a young man without organic heart disease.
He is interested in "body-building" and is totally asymptomatic.
Right axis deviation may be a normal variant in children or young adults.

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