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Electrocardiogram in a Neonate Presenting with Failure

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Insights into Electrocardiograms with MCQs

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Abstract

Echocardiography is necessary for exact and detailed diagnosis of congenital heart disease in a neonate who presents with heart failure. However, clinical examination correlated with surface electrocardiogram help in narrowing the differential diagnosis. This helps the echocardiographer in a more focused approach for final diagnosis. Clinico-electrocardiographic approach is discussed with representative electrocardiograms. Flow charts help in easy memorization of the approach. Summary and MCQs at the end of the chapter help in quick revision and self-assessment.

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Author information

Authors and Affiliations

  1. Ex Senior professor and head of the department of cardiology, Jawaharlal Nehru Medical College, Ajmer, India

    Sitaram Mittal

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  1. Sitaram Mittal
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Appendices

Summary

  • Tachycardia for age with P wave abnormality suggests the possibility of supraventricular tachyarrhythmia.

  • Combination of right axis deviation, right atrial enlargement, and low voltage splintered QRS in lead V1 in absence of any electrocardiographic sign of RVH suggest the possibility of Ebstein anomaly.

  • Combination of right axis deviation and right ventricular hypertrophy without right atrial enlargement and transition from R wave in lead V1 to RS in lead V2 suggests the possibility of tetralogy of Fallot with pulmonary atresia.

  • Combination of right axis deviation, right ventricular hypertrophy, and right atrial enlargement with absence of left ventricular forces is seen in severe coarctation of aorta, complete interruption of the aortic arch, hypoplastic left heart syndrome, severe pulmonary vein stenosis, total anomalous pulmonary venous drainage with obstruction, severe pulmonary valve stenosis with intact ventricular septum or transposition of the great arteries.

  • Combination of right axis deviation, right ventricular hypertrophy, and biatrial enlargement is seen in critical aortic stenosis, congenital mitral stenosis, stenosing ring above the mitral valve or cor triatriatum.

  • Combination of right ventricular hypertrophy and right atrial enlargement with left axis deviation suggests the possibility of severe stenosis of dysplastic pulmonary valve with Noonan syndrome.

  • Combination of right axis deviation, rsr’ in lead V1 without right atrial enlargement suggests the possibility of severe pulmonary regurgitation due to congenital absence of the pulmonary valve.

  • Q wave with tall R wave, ST-segment depression, and T wave inversion in leads V5 and V6 and left atrial enlargement suggest the possibility of primary endocardial fibroelastosis.

  • Left ventricular dominance with normal QRS axis suggests the possibility of pulmonary atresia with intact interventricular septum.

  • Left ventricular dominance with left axis deviation suggests the possibility of tricuspid atresia with pulmonary atresia.

  • Left ventricular dominance with right upper quadrant axis suggests the possibility of critical pulmonary stenosis.

MCQs

Q1. What could be the causes of respiratory distress in a neonate?

  1. (a)

    Hyaline membrane disease

  2. (b)

    Methemoglobinemia

  3. (c)

    Hypoglycemia

  4. (d)

    Right aortic arch

Q2. What could be the cause of heart failure with irregular rhythm in a neonate?

  1. (a)

    Idiopathic respiratory distress syndrome

  2. (b)

    Atrial flutter

  3. (c)

    Atrial fibrillation

  4. (d)

    All

Q3. In a new born, positive T waves in leads V1 and V2 suggest:

  1. (a)

    Severe right ventricular hypertrophy

  2. (b)

    Severe left ventricular hypertrophy

  3. (c)

    Biventricular enlargement

  4. (d)

    None

Q4. In a new born, T waves in leads V1 and V2 become inverted in:

  1. (a)

    First week of life

  2. (b)

    After one month

  3. (c)

    After three months

  4. (d)

    After one year

Q5. In a new born, positive T waves in leads V1 and V2 after seven days of birth suggest:

  1. (a)

    Right ventricular hypertrophy

  2. (b)

    Left ventricular hypertrophy

  3. (c)

    Biventricular hypertrophy

  4. (d)

    None

Q6. In a neonate with heart failure, qR in V1, peaked P waves, and positive T waves in leads V1 and V2 beyond 3 days of life suggest the possibility of:

  1. (a)

    Hypoplastic left heart syndrome

  2. (b)

    Congenital mitral stenosis

  3. (c)

    Severe aortic stenosis

  4. (d)

    Severe pulmonary valve stenosis

Q7. In a neonate with heart failure, qR in lead V1, upright T wave in leads V1 and V2 beyond three days of life with biatrial enlargement suggest the possibility of:

  1. (a)

    Congenital mitral stenosis

  2. (b)

    Stenosing ring above mitral valve

  3. (c)

    Hypoplastic left heart syndrome

  4. (d)

    Severe pulmonary vein stenosis

Q8. In a neonate with heart failure, without cyanosis or murmur, normal QRS axis, left ventricular hypertrophy with depression of the ST-segment, and inversion of the T wave in leads V5 and V6, suggest the possibility of:

  1. (a)

    Critical aortic stenosis

  2. (b)

    Complete interruption of the aortic arch

  3. (c)

    Pulmonary atresia

  4. (d)

    Primary endocardial fibroelastosis

Q9. In a neonate with heart failure, without cyanosis, short low-pitched early diastolic murmur along left upper sternal border, right axis deviation, rsr’ in lead V1 without peaked P wave suggest the possibility of:

  1. (a)

    Large secundum ASD

  2. (b)

    Large primum ASD

  3. (c)

    Congenital absence of pulmonary valve

  4. (d)

    LV-RA shunt

Q10. In a neonate with central cyanosis and heart failure, the presence of right axis deviation and right ventricular hypertrophy without tall P waves suggests the possibility of:

  1. (a)

    Tetralogy of Fallot

  2. (b)

    Pulmonary atresia

  3. (c)

    Ebstein anomaly

  4. (d)

    None

Q11. In a neonate with central cyanosis and heart failure, right axis deviation, rsR’ in lead V1, and tall peaked P waves suggest the possibility of:

  1. (a)

    Tetralogy of Fallot

  2. (b)

    Tricuspid regurgitation

  3. (c)

    Total anomalous pulmonary venous connection with obstruction

  4. (d)

    Tricuspid atresia

Q12. In a neonate with central cyanosis and heart failure, normal QRS axis and prominent R wave with prominent positive T waves in leads V5 and V6 suggest the possibility of:

  1. (a)

    Pulmonary atresia

  2. (b)

    Tricuspid atresia

  3. (c)

    Critical pulmonary stenosis

  4. (d)

    Critical aortic stenosis

Q13. In a neonate with central cyanosis and heart failure, left axis deviation with prominent R and prominent positive T waves in leads V5 and V6 suggest the possibility of:

  1. (a)

    Tricuspid atresia

  2. (b)

    Pulmonary atresia

  3. (c)

    Aortic atresia

  4. (d)

    None

Q14. In a neonate with central cyanosis and heart failure, left axis deviation, right ventricular hypertrophy, and tall P waves suggest the possibility of:

  1. (a)

    Tricuspid atresia

  2. (b)

    Pulmonary atresia

  3. (c)

    Severe pulmonary stenosis

  4. (d)

    Noonan syndrome with severe pulmonary stenosis

Q15. In a neonate with central cyanosis, systolic murmur over left lower sternal border, right axis deviation, tall P waves, low voltage splintered QRS in lead V1 but no right ventricular hypertrophy suggest the possibility of:

  1. (a)

    Severe valvular pulmonary stenosis

  2. (b)

    Tricuspid atresia

  3. (c)

    Ebstein anomaly

  4. (d)

    Tetralogy of Fallot

Answers

(1) a,c (2) c (3) d (4) a (5) a (6) a (7) a,b (8) d, (9) c (10) a (11) c (12) a (13) a (14) d (15) c

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© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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Mittal, S. (2023). Electrocardiogram in a Neonate Presenting with Failure. In: Insights into Electrocardiograms with MCQs. Springer, Singapore. https://doi.org/10.1007/978-981-99-0127-2_49

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  • DOI: https://doi.org/10.1007/978-981-99-0127-2_49

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-0126-5

  • Online ISBN: 978-981-99-0127-2

  • eBook Packages: MedicineMedicine (R0)

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