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July 1986

The Heart Is Under the Lower Third of the Sternum: Implications for External Cardiac Massage

Author Affiliations

From the Departments of Anesthesiology (Drs Finholt, Kettrick, and Swedlow) and Pediatrics (Dr Wagner), University of Pennsylvania School of Medicine, Philadelphia, and Children's Hospital of Philadelphia. Dr Finholt is now with the Department of Anesthesiology, University of Cincinnati Medical Center.

Am J Dis Child. 1986;140(7):646-649. doi:10.1001/archpedi.1986.02140210044022

• Current guidelines for cardiopulmonary resuscitation in children state that the heart lies under the midsternum in infancy and descends with age. To verify this statement, we studied 55 patients, aged 1 day to 19 years, including eight premature infants, during either routine chest x-ray films or right-sided heart angiography. Using a Cartesian coordinate system determined by radiopaque markers placed on the chest, and computer digitization, we located the center of each patient's cardiac silhouette and/or right ventricle. Using descriptive statistics, we found that the heart lay under the lower third of the sternum in all age groups. Analysis of variance indicated that there was no significant difference in this location between age groups. These results suggest that recommendations for external cardiac massage in infants and children may need to be revised.

(AJDC 1986;140:646-649)

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