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

Yıl 2020, Cilt: 8 Sayı: 3, 464 - 470, 20.12.2020

Gülhan Tunca Şahin , Erkut Ozturk

https://doi.org/10.37696/nkmj.768667

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

Destekleyen Kurum

yok

Proje Numarası

yok

Teşekkür

-

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

Öz

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.

Anahtar Kelimeler

child, electrocardiography, congenital, heart diseases

Proje Numarası

yok

Kaynakça

• 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.