Atlas of Pediatric and Youth ECG – One of the most fascinating and mysterious aspects of an ECG is the wealth of information hiding behind a seemingly innocent tracing. The ECG is a technically simple examination that produces familiar writing on a piece of paper, in a language that has stayed the same since it was invented more than a century ago.
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While echocardiography now uses machines that produce images that even 20 years ago were unimaginable, an ECG performed today displays the same signs seen by the founding fathers of electrocardiography, from Einthoven onward. In the space of a century, we have discovered the many diseases that can lie concealed between the waves, from channelopathies to cardiomyopathies, from arrhythmic syndromes to congenital heart diseases.
In the meantime, the ECG has been supported but not replaced by the new imaging techniques and has earned a precise role in screening programs for various conditions, in particular in sports preparticipation screening for prevention of sudden cardiac death, a program that is already strongly supported in Italy but which is now spreading throughout the world. Without getting into any discussion, it is known that the “Italian” position considers the ECG to be a cost-effective method. The ECG is generally satisfactory in terms of specificity and sensitivity; in other words, a normal ECG reassures the cardiologist and the families of young sports players.
The most important thing, however, is to recognize when an ECG is normal, avoiding false-positive results and all related implications in terms of additional tests and examinations as well as the risk of discouraging sports activities. Sports activities aside, ECG still plays a key role in the diagnosis of arrhythmias and ischemic syndromes.
Nevertheless, the interpretation and deductive analysis of an ECG is no easy task, but requires curiosity, clinical experience, and culture. There are no shortcuts, and the quick routes on a cardiac map are usually accessory pathways and should not be followed. The ECG seizes and stops the anatomy of an instant, a hermeneutic process even more difficult in babies and in the young where the heart is changing day by day.
This continuous alteration during developmental age takes the cardiologist by surprise: in the attempt to keep up with the new methods and the enormous number of publications, he or she has been obliged to neglect electrocardiographic semeiotics and now struggles to interpret the tracings of a newborn, of a youngster with normal variants, or of a 60-year-old who has had cardiac surgery and suffers from hidden congenital heart disease.
One of the particular features of this book is that all the tracings come from the same tertiary center. They were selected from thousands of tracings that I have personally collected over the last 20 years and which allowed me to make or confirm a diagnosis. The part for electrophysiology experts is kept to a minimum in order to leave room for examples and tracings that everyone working in the medical sector can understand.
The ECGs that a pediatric cardiologist sees in a lifetime, the ones that a pediatrician imagines in his or her patients and that a cardiologist of adult patients fears when he or she is on night duty, are all included and commented on. This atlas can be also of interest to other players in the field of medicine – anesthetists, students, and nurses – who may be the first to see the mysterious pink paper emerging. No one should feel left out since, as Tolstoy would say, all normal ECGs look alike, but every ECG is in its own way abnormal.