The effect of axis values on electrocardiography in prediction of congenital heart diseases in children without a known history of heart disease

Abstract

Objective:In this study,the predictive value of electrocardiography(ECG) axis measurements at diagnosis of congenital heart diseases(CHD) were evaluated in children.

Material and Method:The children between 1 month and 16 years of age without a known history of CHD who applied to pediatric cardiology outpatient clinic were included in the study.Pathology at physical examination,P,QRS,T axis and QRS-T angle values and the diagnosis of a CHD at echocardiography were evaluated.Results were evaluated statistically.

Results:Two hundred and sixty cases were evaluated during the study period.Median age was 24 months(1-160months).The 45% of the patients were evaluated as normal at cardiovascular system examination.Murmur was present in 40% of the patients and other pathologic findings additionally to the murmur were found in another 15% of the patients.ECG evaluations revealed abnormal P axis in 5 patients,left axis deviation in 23 patients,right axis deviation in 29 patients, superior axis in 3 patients,abnormal T axis in 18 patients and pathologic QRS-T angle in 32 patients.Echocardiographic stuies revealed CHD at 68 patients.The pathology at physical examination did not effect the ECG axis values and the abnormal changes at QRS-T angle(p>0.05)but signicantly increasing the frequency of CHD diagnosis at echocardiography(p<0.05).The presence of CHD was not found different in terms of P,QRS and T axis.Congenital heart disease was found significantly higher in patients especially with left axis deviation,QRS-T angle pathology and abnormal T axis(p<0.05).

Conclusion:Children with pathological auscultation findings at the cardiovascular system examination, left axis deviation or pathological QRS-T angle at ECG should be evaluated by transthoracic echocardiography.

Keywords

• child
• electrocardiography
• congenital
• heart diseases

Bilinen Kalp Hastalığı Öyküsü Olmayan Çocuklarda Elektrokardiyogram Aks Değerlerinin Konjenital Kalp Hastalığını Öngörmedeki Etkisi

Öz

Giriş ve Amaç: Bu çalışmada Elektrokardiyografi (EKG)’de ölçülen aks değerlerinin çocuklarda Konjenital Kalp Hastalığı(KKH) tanısını saptamadaki öngörüsü araştırıldı.

Materyal ve Method:Çocuk kardiyolojisi polikliniğine başvuran ve öncesinde bilinen kalp hastalığı öyküsü bulunmayan, yaşı >1 ay ile <16 yaş arasındaki çocuklar çalışmaya alındı.Fizik muayenede patoloji varlığı, EKG’de P,QRS,T aksı ve QRS-T açısı değerleri ve ekokardiyografide konjenital kalp hastalığı varlığı araştırıldı.Sonuçlar istatistiksel olarak değerlendirildi.

Bulgular: Çalışma döneminde 260 olgu mevcuttu. Median yaş 24 ay(1 -160 ay) idi.Yapılan kardiyovasküler sistem fizik muayenesinde % 45 olgu normal olarak değerlendirildi. Yüzde 40 olguda üfürüm ve yüzde 15 olguda üfürüme ek olarak diğer patolojik bulgular görüldü.EKG’de 5 olguda anormal P aksı, 23 olguda sol aks deviasyonu,29 olguda sağ aks deviasyonu, 3 olguda süperior aks,18 olguda anormal T aksı ve 32 olguda patolojik QRS-T açısı saptandı.

Yapılan ekokardiyografide 68 olguda konjenital kalp hastalığı saptandı.Fizik muayenede patoloji varlığı EKG aks değerlerini ve QRS-T açısındaki anormal değişiklikleri etkilemiyordu(p>0.05)ancak ekokardiyografide  konjenital kalp hastalığını görülmesini anlamlı artırmaktaydı(p<0.05).Konjenital kalp hastalığı varlığı EKG’de P,QRS ve  T aksları açısından farklı değildi.Özellikle sol aks deviasyonu,QRS-T açısında patoloji olma durumu ve anormal T açısı  olan olgularda konjenital kalp hastalığı görülme olasılığı anlamlı olarak yüksek bulundu(p<0.05).

Sonuç:Kardiyovaskuler sistem muayenesinde patolojik dinleme bulguları gözlenen, EKG’de sol aks deviasyonu görülen veya QRS-T açısının patolojik saptandığı çocuk olgular transtorasik ekokardiyografi ile değerlendirilmelidir.

Anahtar Kelimeler

• çocuk
• elektrokardiyografi
• konjenital
• kalp hastalığı

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