ECG Central


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Thanks to the awesome people at the Princess Margaret Hospital for Children in Perth, here is a guide to paediatric ECGs…


General approach to ECGs

Placement of ECG leads

Normal ECGs for various ages






Intervals and waves

PR interval

QRS complex

QT interval

P wave

T wave

Q waves

U wave

ST segment

Abnormal findings

Ventricular hypertrophy



Myocardial infarction/ischaemia

Calcium abnormalities

Potassium abnormalities

Pulmonary embolism



ECG Lead Placement

In young children, the right ventricle normally extends to the right side of the sternum. To appropriately display right ventricular potentials, ECGs for children in the under five‐year age group must include an extra lead (‘V4R’) on the right side of the chest at a point analogous to the left sided V4.

Precordial leads:

  • V4R: 5th intercostal space, right midclavicular line
  • V1: 4th intercostal space, right sternal border
  • V2: 4th intercostal space, left sternal border
  • V3: use this lead for V4R, must label as such on ECG.
  • V4: fifth intercostal space, right midclavicular line
  • V5: anterior axillary line, same horizontal plane as V4
  • V6: midaxillary line, same horizontal line as V4.

Limb leads:

  • Place on top part of arm or leg (less muscle interference)

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