An interesting ecg of a 2yr old

If you look carefully there's right Axis deviation, and RVH. but if you still look closer at the long lead II, there's a distinct pattern. There are p waves superimposed on the T waves. This is called p on t phenomenon. If you look into more details there's a 1:2 block. This is 2nd degree mobitz type 2 block as the qrs duration is normal : <120ms. The differentiating factor from Mobitz type 1is the qrs duration. Mobitz type 2 is infrahisian (originating below bundle of His).Infra hisian blocks arise below the bundle of His and are usually more dangerous than suprahisian as they indicate some damage to the LV conduction system.The T inversions in V1 ,V2 ,V3 are a normal variation in kids up till 5yrs of age.If this persists beyond this age its called persistent Juvenile pattern.
The ECHO of this kid revealed an ostium secondum defect of 11 mm.RA/RV ENLARGEMENT,MILD PULMONARY STENOSIS AND MILD AORTIC STENOSIS ,mod TR.ECHO A4C confirms the ASD by demonstrating turbulence and a gradient across the septal defect as seen in the picture.