Published online August 1, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. 440-444 (doi:10.1542/peds.2007-0170)
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EXPERIENCE & REASON

Electrocardiographic Diagnosis of Myocardial Ischemia in Children: Is a Diagnostic Electrocardiogram Always Diagnostic?

Avihu Z. Gazit, MD, Jennifer N. Avari, MD, David T. Balzer, MD and Edward K. Rhee, MD

Division of Pediatric Cardiology, Washington University School of Medicine–St Louis Children's Hospital, St Louis, Missouri

ABSTRACT

Electrocardiographic criteria for the diagnosis of cardiac ischemia in adults are well defined; however, analogous criteria for the diagnosis of cardiac ischemia in infants and children remain ambiguous. The difficulty in defining electrocardiographic criteria in pediatrics relates to age-dependent differences in the pediatric electrocardiogram, the presence or absence of congenital heart disease, and multiple and diverse etiologies of myocardial injury that lead to an ischemic pattern on the electrocardiogram. In this report, we illustrate 3 pediatric cases in which the electrocardiogram met adult diagnostic criteria for acute transmural myocardial infarction, without coronary artery abnormalities in 2 cases and with a transient coronary abnormality in the third. In conclusion, ST-segment changes diagnostic of transmural myocardial infarction in adults may be seen in pediatric patients in the absence of coronary artery occlusion.

Key Words: pediatric • ischemia • electrocardiogram • infarction

Abbreviations: ECG, electrocardiogram • MI, myocardial infarction

Accepted Mar 22, 2007.


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