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

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

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

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,

PDF

___

Tworetzky W, McElhinney DB, Brook MM,Reddy VM, Hanley FL, Silverman NH. Echocardiographic diagnosis alone for the complete repair of major congenital heart defects. J Am Coll Cardiol. 1999;33(1):228–33.
Frommelt P. Update on pediatric echocardiography. Curr Opin Pediatr 2005;17(5):579–85.
Fisch C. Centennial of the string galvanometer and the electrocardiogram.J Am Coll Cardiol. 2000;36(6):1737–45.
Ravi P, Ashwath R, Strainic J, Li H, Steinberg J, Snyder C. Clinical and financial impact of ordering an echocardiogram in children with left axis deviation on their electrocardiogram. Congenit Heart Dis 2016;11(2):110–14.
Schneider AE, Cannon BC, Johnson JN, Ackerman MJ,Wackel P. Left Axis Deviation in Children Without Previously Known Heart Disease. Pediatrics. 2018;141(3):e20171970.
Davignon A, Rautaharju P, Boisselle E, Soumis F, Megelas M, Choquette A. Normal ECG standards for infants and children. Pediatr Cardiol 1980;1(2):123–31.
Bu G, Miao Y, Bin J,. Comparison of 128‐slice low‐dose prospective ECG‐gated CT scanning and trans‐thoracic echocardiography for the diagnosis of complex congenital heart disease. PLoS One. 2016;11(10):e0165617.
Marek J, Skovránek J, Hucín B, Chaloupecký V, Tax P, Reich O, Samánek M. Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients. Cardiology 1995;86(6):488-95.
Advani N, Menahem S, Wilkinson JL. The Diagnosis of innocent murmurs in childhood. Cardiol Young. 2000;10(6):340-42.
Hansen LK, Birkebaek NH, Oxhoj H. Initial evaluation of children with heart murmurs by the nonspecialized pediatrican. Eur J Pediatr. 1995;154(1):15-7.
Rajakumar K, Wiesse M, Rosas A, Erdoğan G, Pyles L. Comparative study of clinical evaluation of heart murmurs by general pediatricians and pediatric cardiologist. Clinical Pediatrics. 1999;38(9):511-8.
Kamasak T,Dilber E. Çocukluk Çağındaki Masum Üfürümlerin Tanısında Fizik Muayene, Elektrokardiyografi, Telekardiyografi ve Ekokardiyografinin Yeri. Online Türk Sağlık Bilimleri Dergisi 2019;4(3): 360-76.
McElhinney DB, Straka M, Goldmuntz E, Zackai EH. Correlation between abnormal Cardiac physical examination and echocardiographic findings in neonates with Down syndrome. American ,Journal of Medical Genetics. 2002;113(3):238-41.
Tanawuttiwat T, Vasaiwala S, Dia M. Mirror mirror (ECG image of the month) Am J Med. 2010;123(1):34–6.
Kurbel: A vector-free ECG interpretation with P, QRS & T waves as unbalanced transitions between stable configurations of the heart electric field during P-R, S-T & T-P segments. Theoretical Biology and Medical Modelling 2014; 11(1):10.
Rautenburg HW, Wagner R .Left anterior hemiblock (left axis deviation) in the ECG of children before and after heart surgery. Klin Padiatr 1983;195(4):256–62.
Moraes DN, Nascimento BR, Beaton AZ. Value of the Electrocardiographic (P Wave, T Wave, QRS) Axis as a Predictor of Mortality in 14 Years in a Population With a High Prevalence of Chagas Disease from the Bambuí Cohort Study of Aging. Am J Cardiol. 2018;121(3):364-69.