Pediatric ECG Lead Placement

Pediatric Cardiology Center of Oregon (PCCO) has been at the forefront of medical care for children and adults with congenital heart disease since first opening its doors in 1986.

PCCO’s pediatric heart program has pioneered important advances in the treatment of congenital heart disease. Plus, our affiliation with Legacy Emanuel Hospital and the Randall Children’s Hospital means that our patients receive first-rate care in a state-of-the-art building designed and built specifically to promote a healing environment for children.

As part of our continuing effort to educate the broader community about our medical services and best practices for treating children with congenital heart disease, we thought we’d take a moment to go over the basics of pediatric ECG lead placement. 

pediatric ecg lead placement

Pediatric ECG Lead Placement

Americans may be more familiar with the acronym “EKG” (which derives from the German Elektrokardiogramm), but most medical practitioners use “ECG” (electrocardiogram) for the process of recording the heart’s electrical activity using electrodes.

The electrodes are placed at specific points on the patient’s skin in order to detect electrical changes in the heart that may indicate cardiac problems.

It’s the placement of the ECG leads (labeled with a V) that we’re focusing on here.

(Quick note: At PCCO, we follow adult guidelines for pediatric patients weighing 90 pounds or more. See below for infants, toddlers, and children weighing less than 90 pounds.)

ECG Basics

  • V1 4th intercostal space to the right of the sternum (about ½ inch to 1 inch from the midline)
  • V2 4th intercostal space to the left of the sternum (about ½ inch to 1 inch from the midline)
  • V3 Midway between V2 and V4
  • V4 5th intercostal space at the midclavicular line (at the nipple line)
  • V5 Anterior axillary line at the same level as V4 (where the ribs curve back)
  • V6 Midaxillary line at the same level as V4 and V5 (should be below the armpit) 

Extra Pediatric Leads for 15 Lead

Right side of chest:

  • V3R Midway between V1 and V4R
  • V4R 5th intercostal space at the midclavicular line (about nipple line)

Left side of chest:

  • V7 after V6

For infants, toddlers, and children under 90 lbs, measuring rib spaces is not usually possible.

  • V1 Nipple line to the right of the sternum (about ½ inch from the midline)
  • V2 Nipple line to the left of the sternum (about ½ inch from the midline)
  • V3 Midway between V2 and V4
  • V4 Below the nipple at the midclavicular line
  • V5 Anterior axillary line at the same level as V4 (about where the ribs curve back)
  • V6 Midaxillary line at the same level as V4 and V5 (should be below the armpit)

Extra Pediatric Leads for 15 Lead

Right side of chest:

V3R Midway between V1 and V4R

V4R Below the nipple at the midclavicular line

Left side of chest:

V7 after V6

For all ECGs, limb leads should be placed on the limbs — not the torso.

Arm leads should be placed just above the elbows.

Leg leads should be placed between the knee and ankle.

One final tip: If computer interpretation reads “Right Superior Axis Deviation” or “Northwest Axis,” be sure to check the limb leads. 

Pediatric Cardiology Center of Oregon

PCCO operates outreach clinics throughout Oregon and Southwest Washington, so we’re never too far away.

Contact Pediatric Cardiology Center of Oregon for more information on our world-class pediatric care and to find a location near you.

After Hours Emergency

After Hours Emergency

Pediatric Cardiology Center of Oregon


300 N. Graham Street, #250

Portland, OR 97227

In case of an emergency after hours or on weekends, please call our office at 503-280-3418. You will be connected to our answering service and an on-call provider will be notified.

Please limit after-hours calls to emergencies. (Refill requests should be made during operating hours, allowing 48 hours for our staff to handle your request.)

In some cases, your questions or concerns — especially those not specific to the heart, cardiac medications or recent heart surgery — may be more appropriately directed to a pediatrician or primary care provider.

However, we would like you to contact us at 503-280-3418 if you have any questions about wound infections or pacemaker pocket infections, instead of calling a primary care provider.

Please remember to deactivate your anonymous call rejection by dialing *87 so that our cardiologist can reach you. Sometimes the cardiologist may be dealing with an emergency, so please feel free to call 503-280-3418 again if your call has not been returned within 15 minutes.

Thank you!


Your Friends at the Pediatric Cardiology Center of Oregon

An Oregon pediatric cardiology program that works for you: PCCO

For more than three decades, the Pediatric Cardiology Center of Oregon (PCCO) has been pioneering care for children with congenital heart disease.

Based at Randall Children’s Hospital at Legacy Emanuel Medical Center in Portland, PCCO has been at the forefront of several pediatric cardiology breakthroughs.

For example, in 2016, Dr. James Kyser became the first and only pediatric cardiologist in Oregon to provide the Edwards SAPIEN XT transcatheter heart valve procedure for pulmonic valve replacement to pediatric patients.

Baby doctor stethoscope PCCO (STOCK PHOTO)

Dr. Kyser also provides these special procedures, among others: interventional cardiology, PFO device closure, Melody Valve placement (percutaneous pulmonary), VSD device closure, PDA device closure, as well as the Fontan, Norwood and hybrid procedures.

At PCCO, we performed the first Norwood procedure for hypoplastic left heart syndrome in Oregon as well as the first arterial switch operation for transposition of the great arteries. Our affiliation with the Randall means children can be treated in a new, state-of-the-art facility designed specifically to promote a healing environment.

Additionally, as leaders in the field of fetal medicine, two of our cardiologists are fellowships trained in advanced imaging, such as cardiac MRI and cardiac CT.

Pediatric Cardiology Center of Oregon

The provider team at PCCO specializes in pediatric and fetal cardiology, interventional pediatric cardiology, pediatric electrophysiology pacing, and advanced cardiac imaging. We’re also fully equipped to provide nonsurgical repair procedures for many heart defects in our cardiac catheterization laboratory.

Best of all, as the premier Oregon pediatric cardiology program, our staff regularly travels to our Oregon clinics in Albany, Springfield, Pendleton, Eugene, Medford, Grants Pass, Bend, Salem and The Dalles, as well as our Washington clinics in Longview and Vancouver. We understand the difficulties faced by many families forced to travel long distances for vital medical appointments, so our statewide outreach is designed to relieve parents and young patients of this burden.

At Pediatric Cardiology Center of Oregon, we believe that everybody — especially the little ones — deserve top-notch care. That’s why we’ll work to formulate a treatment plan that works best for your family.

Payment Arrangements

We accept most insurance plans — but we’re also happy to make other financial arrangements including personal checks, cash, money orders and most major credit cards. Finally, we’re sensitive to the fact that some families need additional payment arrangements, and we’re more than happy to assist in this regard.

If you have any questions whatsoever, please contact PCCO. For appointment information, it’s best to get in touch with PCCO as far in advance as possible. And, of course, you may call our billing office directly at 866-622-2455 or 360-667-3045. We’re here to serve you.

The Pediatric Cardiology Center of Oregon is located at 300 N. Graham St, #250, Portland, OR 97227. You can reach us by phone at 503-280-3418 or fax at 503-284-7885. Our website has useful patient and family education, resource links, and maps to reach our locations.

Heart Healthy Practices for Children

Many parents no doubt ask themselves what they can do to ensure their child lives a long, happy and healthy life. And if you’re the parent of a child born with a congenital heart disease (CHD), you may be wondering how to keep your child’s heart healthy.

Fortunately, there are a lot of ways to incorporate heart-healthy daily practices into your child’s life. We’ve listed a few below.

But first, it’s important to speak with your child’s cardiologist in order to determine the best course of action. You can also contact the Pediatric Cardiology Center of Oregon if you have any questions. If your child has been diagnosed with a heart defect, call us at 503-280-3418. Our caring staff is here for you.

How to Keep Your Child’s Heart Healthy

Make sure your child gets enough sleep

A healthy sleep regimen means going to sleep at the same time of night and waking up at the same time of day — every day, including weekends and holidays. It’s also a Sleeping childgood idea to limit the child’s use of electronic devices within an hour or so before bedtime. Consider installing blackout curtains in the child’s bedrooms; this is especially useful here in the Pacific Northwest, when summer bedtimes may occur before the sun has set.

Feed them a healthy diet

Like most of the items on this list, eating a healthy diet is good advice for everyone, not just children. The key is to start kids early on a low-sugar diet rich in a variety of vegetables, fruits, whole grains and lean proteins so that they’ll develop habits that last a lifetime. These foods in their proper portions will help your child maintain a healthy weight and a stable metabolism. And, of course, make sure they drink enough water.

You might also consider supplementing your child’s diet with healthy fatty acids, such as omega-3 and omega-6 and limiting your child’s consumption of energy drinks.

Let them play sports — but get a physical first

Most children with congenital heart disease can play sports without any negative health repercussions. It’s important that your child remain active. Plus, playing on sports teams enhances a child’s sense of belonging and confidence, and it also encourages proper social development.

But first, be sure your child is given a sports exam or physical prior to engaging in strenuous cardio exercises. A doctor will examine your child for any abnormalities that might prove unsafe for active children. For example, a doctor might diagnose a heart murmur, which could possibly rule out intense physical exercise.

Some physical activities, including endurance sports, may be a good choice for a child with CHD. For instance, swimming, running, cycling, rowing, cross-country skiing and tennis may all be good choices.

Bottom line: Children with heart disease need exercise. Find out what your child loves to do, and let them do it!

Teach your child to practice stress management techniques

Child doing yogaWe usually tend to think of yoga, meditation and deep-breathing exercises as something that only stressed-out adults need to do. But these ancient practices can do wonders for children, especially those who must take extra care of themselves due to CHD.

There are plenty of resources out there that can help you and your child find which combination of stress management activities is right for them.

Practice these techniques — as well as those listed above — alongside your child, and you’ll be well on your way to ensuring that they develop habits to keep them informed, engaged, strong, vital and healthy for the rest of their lives.

Children’s Heart Center at Randall Children’s Hospital

Randall Children's Hospital

The pediatric cardiology center at Randall Children’s Hospital boasts a state-of-the-art medical facility with a full team of cardiology specialists who are focused on providing their young patients with the best care possible. The Randall Children’s Hospital in Portland, Oregon prides itself on offering the best treatment for their young patients, with a team of individuals focused on cardiology, surgical procedures, and other aspects of a child’s development that can all come together to ensure that they get the playful, healthy life they deserve.

Read more: Children’s Heart Center at Randall Children’s Hospital

What Is Pediatric Arrhythmia?


An arrhythmia is when a heart beats irregularly. The condition can cause the heart to beat too quickly, too slowly or unevenly. If your child's doctor finds an arrhythmia, they may recommend diagnostic tests or refer you to a pediatric cardiologist.

Heart rate measures a heart’s beats per minute. A child's resting heart rate is around 70. Infants' hearts beat about 140 times per minute. Heart rhythms are ordinarily regular, though they speed and slow during different activities. 

An arrhythmia can be present at birth or develop later. Sometimes an irregular heartbeat doesn't have symptoms. Doctors often find the problem during routine exams. If your child's pediatrician notices an arrhythmia, they will evaluate her medical history. Report health concerns to your doctor during the exam.

How Are Arrhythmias Treated?

We have various therapies for our patients with irregular heart beats. The recommended treatment depends on the patient's condition. Here are some of the therapies pediatric cardiologists recommend for children with an arrhythmia:


We can treat some disorders with drugs. Tachycardias, a condition where the heart beats too fast, may be improved with medication. Medicine doesn't cure an arrhythmia but may prevent or shorten an episode of irregular beats.

If your child's physician prescribes a drug, your child may need to take a dose every day or she may need it only when her heart beats abnormally. Some patients begin drug treatment in a hospital where they can be monitored for side effects. A doctor may need to prescribe several drugs before finding the right medication.

Radiofrequency Ablation

Serious arrhythmias may require more than medication. A physician may recommend a permanent remedy if a child's condition is life-threatening. A radiofrequency catheter ablation is a non-invasive procedure. The pediatric cardiologist uses several catheters to change the part of the heart that causes the irregularity.


Physicians treat some patients with open surgery. The surgeon will alter the heart to interrupt the abnormal connection causing the problem.

Artificial Pacemaker

An artificial pacemaker can improve some types of irregularities. A pacemaker is a small device that helps the heart beat regularly. Cardiologists implant pacemakers inside a child's abdomen or next to the chest wall, connecting it to the heart with a thin wire. The pacemaker sends electricity to the heart to help it beat. The current does not hurt. 

Pacemakers are prescribed most often for a low heart rate. A child with a pacemaker must visit a cardiologist regularly for checkups. Children with these devices are usually able to engage in normal activities though your pediatric cardiologist may advise against contact sports.

Your Pediatric Cardiology Resource

Pediatric Cardiology of Oregon treats children who have heart problems. We have offices in Portland, Oregon and outreach locations in Oregon and Southwest Washington. Contact us for an appointment here.

Pediatric Cardiologist First Visit and How to Prepare

First visit to pediatric cardiologist

New patients come to us when a primary care physician notices something that needs evaluation by a pediatric cardiologist. Your child's doctor may have heard a heart murmur. Or, perhaps your son or daughter needs a special test.

Whatever the reason for your first appointment, you'll likely have many questions. We'll do our best to provide you with answers. It's natural to feel anxious the first time you and your child visit a pediatric cardiologist.

Read more: Pediatric Cardiologist First Visit and How to Prepare

Study: Energy drinks dangerous for those with heart conditions

energy drinks study

With more than 500 different products on the market, energy drinks are an increasingly popular choice for teens and young adults. However, researchers say energy drinks can have harmful effects on heart function and blood pressure, especially for those with pre-existing heart conditions.  

Read more: Study: Energy drinks dangerous for those with heart conditions

6 Things to Know About Your Child's Pacemaker

A pediatric cardiologist might recommend a pacemaker if your child has a heart defect that prevents their heart from beating normally.

Doctors at Pediatric Cardiology Center of Oregon can evaluate your child for heart rhythm disorders and care for those who have a pacemaker. Dr. Marc D. LeGras, who joined our group in 1996, specializes in conditions treated with a pacemaker. Our physicians treat patients who need a pediatric cardiologist in Portland. We also work in locations around Oregon and Southwest Washington. Please contact us for more information about making an appointment for your child.

6 of hearts

1. What Is a Pacemaker?

A pacemaker is an electronic device. Surgeons implant them under the skin. The pacemaker regulates an abnormal heart rate or rhythm. A battery provides power. The device monitors the heart's natural electrical signal and can also send a signal to aid the heart to beat properly.


The surgeon might position a pacemaker for an infant or child under the skin near the abdomen. There, fatty tissue offers protection from the rough and tumble of a child's activities. Pacemakers for teens and adults are usually placed near the collarbone.

2. How Do Doctors Monitor a Pacemaker?

After inserting a pacemaker, pediatric cardiologists check your child thoroughly and continue to monitor the pacemaker during office visits. During checks, the cardiologist may take an x-ray or perform other tests. Parents can also check the pacemaker from home. The pacemaker keeps a record that you can send to doctors by phone or over the internet. Your doctor will make sure you understand how to check the pacemaker remotely.

3. Can My Child Play Normally With a Pacemaker?

Many children with pacemakers live a normal, healthy life. Restrictions depend on your child's health. Most kids with heart defects that are being managed by a cardiologist can play, take gym class and participate sports. Your pediatrician may recommend avoiding contact sports. Many other physical activities, such as soccer, swimming, bicycling and more are enjoyed by kids with pacemakers.

4. How Long Does a Pacemaker's Battery Last?

The battery will last for years as will the pacemaker itself. Battery life depends on whether the pacemaker makes each heartbeat or only needs to make a beat periodically. A low battery will show during regularly scheduled checks.

5. What Devices Interfere With a Pacemaker?

Your child's heart doctor will provide you with information about devices that could interfere with a pacemaker. Pacemaker technology has advanced, and things that used to interfere with the devices, such a microwave ovens, today are safe. Your cardiologist will advise you about what types of machinery to avoid.

6. Can My Child go Through a Metal Detector?

Yes, it's OK to pass through a metal detector. If the detector sounds an alarm, inform security that your child has a pacemaker.  Don't allow security personnel to pass the detector wand over the pacemaker. Make sure your child wears a medical bracelet that indicates they have an implanted device.