AXIS Calculation and CONGEnital heart disease in children

A quick clinical pearl for you.
One of the important ECG skills to have, is to be able to diagnose a paediatric ECG. Go to the Paediatric ECG page in the course to quickly read on this.

There are the important things to know which include:

• Kids are right heart dominant, then progressively become left heart dominant
• The intervals are a little different
• The T waves are upright in the first week of life and then flip until adolescence

................ etc

What about the axis?
One of the first things I look at is the AXIS. The paediatric axis should be normal or rightward. If the axis is NORTHWEST, assume a congenital abnormality like a VSD etc.

JUST LOOK at aVF.  If aVF is NEGATIVE= Congenital until proven otherwise.

Below is an example of this. It is a child with an AV Septal Defect, causing biventricular failure. The ECG should be right heart dominant, but it's both right and left dominant.
Look at aVF; it's NEGATIVE. So I know there is a congenital defect.
How will these children present. What are the clinical manifestations of this conditions and others? Go to Paediatric Heart Conditions you must know.

Source: Pediatrics in Review