Down syndrome electrocardiogram

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]


There are no ECG findings associated with Down syndrome however 40-60 percent of patients with Down syndrome suffer from congenital heart defects the most common being atrial septal defect, atrioventricular septal defect, ventricular septal defect, and patent ductus arteriosus. The ECG findings in Down syndrome are of the aforementioned underlying congenital heart defects.


Ventricular septal defect electrocardiogram

Small VSD

  • Restrictive VSD, Qρ/Qѕ < 1.5/1.0 Qρ/Qs is pressure gradient between pulmonary and systemic circulation: EKG is normal.
  • A few patients will have an rsr' in V1.

Medium-sized VSD

  • Left atrial overload - broad notched P wave
  • Left ventricular overload - Deep 'Q' wave, tall 'R' wave, tall 'T' wave in lead V5 and V6
  • Atrial fibrillation can also be seen

Large VSD

  • In adults or adolescence with a large VSD and pulmonary vascular obstructive disease, LVH is absent because volume overload of the LV is no longer present. Large VSD will produce right ventricular hypertrophy with right axis deviation. At this point there is either an rsR' pattern in the right precordial leads, or more commonly, a tall monophasic R wave in the right precordial leads reflecting RVH. Also deep S waves in the lateral precordial leads and tall peaked P waves.

Atrial septal defect electrocardiogram The ECG findings in atrial septal defect vary with the type of defect present.

Lesion Specific Electrocardiogram Findings

Atrioventricular septal defect electrocardiogram

  • Rhythm: normal sinus rhythm, PVCs 30%
  • PR interval: 1° AVB >50%
  • QRS axis: Moderate to extreme LAD; normal with atypical
  • QRS Configuration: rSr´ or rsR´
  • Atrial Enlargement: Possible LAE
  • Ventricular hypertrophy: Uncommon in partial; BVH in complete; RVH with Eisenmenger
  • Particularities: Inferoposteriorly displaced AVN

Patent ductus arteriosus electrocardiogram


  1. Roizen, Nancy J.; Magyar, Caroline I.; Kuschner, Emily S.; Sulkes, Steven B.; Druschel, Charlotte; van Wijngaarden, Edwin; Rodgers, Lisa; Diehl, Alison; Lowry, Richard; Hyman, Susan L. (2014). "A Community Cross-Sectional Survey of Medical Problems in 440 Children with Down Syndrome in New York State". The Journal of Pediatrics. 164 (4): 871–875. doi:10.1016/j.jpeds.2013.11.032. ISSN 0022-3476.
  2. Tubman TR, Shields MD, Craig BG, Mulholland HC, Nevin NC (June 1991). "Congenital heart disease in Down's syndrome: two year prospective early screening study". BMJ. 302 (6790): 1425–7. PMC 1670107. PMID 1829969.
  3. Caro, Milagros; Conde, Diego; Pérez-Riera, Andrés R.; de Almeida, Adail P.; Baranchuk, Adrian (2014). "The electrocardiogram in Down syndrome". Cardiology in the Young. 25 (01): 8–14. doi:10.1017/S1047951114000420. ISSN 1047-9511.
  4. Clark E, Kugler J (1982). "Preoperative secundum atrial septal defect with coexisting sinus node and atrioventricular node dysfunction". Circulation. 65 (5): 976–80. PMID 7074763.
  5. Bizarro RO, Callahan JA, Feldt RH, Kurland LT, Gordon H, Brandenburg RO (1970). "Familial atrial septal defect with prolonged atrioventricular conduction. A syndrome showing the autosomal dominant pattern of inheritance". Circulation. 41 (4): 677–83. PMID 5437412.

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