It has been amply demonstrated that in adults with coronary artery disease the additional use of lead IV of the electrocardiogram may reveal evidence of myocardial damage not disclosed by the three standard leads.1 In view of this finding it was deemed desirable to determine the value of lead IV in children with various types of heart disease, particularly as a means of detecting the presence of an active rheumatic infection of the heart.
To determine the normal variations of this lead in the electrocardiograms of children, we took tracings for twenty children without cardiac disease who were in the hospital for the treatment of various orthopedic conditions. We then took four lead tracings for seventy-eight children who were attending the cardiac clinic. Their ages ranged from 6 to 15 years. Fifty-seven children had organic heart disease, classified etiologically as rheumatic in forty-nine patients and as congenital in eight. In