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Postgraduate Education
BS Physical Therapy, Silliman University, 1996
BS Zoology, MSU-Iligan Institute of Technology 1999
Doctor of Medicine, Mindanao State University-College of Medicine
Post-graduate Internship
University of the Philippines, Philippine General Hospital
2003-2004
Internal Medicine Residency
University of the Philippines, Philippine General Hospital
2004-2007
Fellowship in Cardiology
University of the Philippines, Philippine General Hospital
2008-2011
Affiliations
Fellow, Philippine College of Physcians
Fellow, Philippine Heart Association
Diplomate, Philippine College of Cardiology
JILL IRENE Z. CAPISTRANO MD, FPCP, DPCC
Dr. Jill Irene Z. Capistrano, FPCP,DPCCINTERNAL MEDICINE-CARDIOLOGY
P
Q
R
T
QT
interval
PR
interval
ST
interval
QRS
interval
S
STsegment
PRsegment
J point
Normal Intervals
Heart rate 60 - 100 beats/min
bradycardia < 60
tachycardia > 100
PR interval 0.12 – 0.20 sec
QRS < 0.12 sec
QRS axis - 30º to + 110º
QTc < 0.45 sec
Normal P wave morphology
Normal QRS Complex Morphology
Normal T wave morphology
Guide in Reading ECG
• Standardization & technique
• Rhythm
• Rate: atrial & ventricular
• P wave morphology & duration
• P-R interval
• QRS complex morphology & duration
• ST segment
• T-wave
• U wave
• Q-T interval
Determination of Rhythm
RHYTHM
(Sinus? Regular? Irregular?)
• A.
• B.
• C.
• D.
RHYTHM
(Sinus? Regular? Irregular?)
• A.
• B.
• C.
• D.
Determination of Rate
v v
Measurement of Rate
Measurement of Rate
• Formula 1: 300
# big squares between R-R
• Formula 2: 1500
# small squares between R-R
Normal rate? Bradycardia? Tachycardia?
• A.
• B.
• C.
Determination of Axis
III
I
II
aVLaVR
aVF
Standard Locations of Limb Leads
Determination of Axis
Lead I
Lead aVF
Determine the axis of the ff:
• A.
• B.
• C.
Chamber Enlargement
Standard Locations of Chest Leads
Atrial Enlargement
Atrial EnlargementII V1
B
V1
Ventricular Enlargement
RIGHT VENTRICULAR
HYPERTROPHY
Sokolow-Lyon Criteria:
R in V1 + S in V5-V6 > 11 mm
R in V1 > 7mm
R : S in V1 > 1
RAD > +90 degrees
Additional Criteria:
QR in V1
S1 Q3 pattern
S1 S2 S3 pattern
p pulmonale
A 55F hypertensive sought consult at the ER for a blood pressure of
150/100. You requested for ancillary procedures, including an ECG.
20 X 2
Sinus rhythm, normal axis, left ventricular hypertrophy
13 X 2
S in V1 + R in V5 or V6 >
35mmLEFT VENTRICULAR
HYPERTROPHY
A 24 year-old male with Atrial Septal Defect
was admitted for shortness of breath.
Interval between QRS complex < 3major
divisions
1500/# small squares = 1500/12 = 125
beats/min
SINUS TACHYCARDIA
P waves tall and pointed in II and
aVF RIGHT ATRIAL
ENLARGEMENT
QRS downward in lead I and
upright in lead aVF
RIGHT AXIS
DEVIATION
Sinus tachycardia, right axis deviation, right atrial abnormality, right ventricular
hypertrophy
QRS upright in V1
RIGHT VENTRICULAR
HYPERTROPHY
Prominent S waves across precordial
leads
LAE, RAE, RVH
LAE
P pulmonale
RVH
Bundle Branch Block
A 24 year old female admitted for heart murmur.
Normal sinus rhythm, right bundle branch block
QRS complex >120 msec
Delayed intrinsicoid deflection time in
V1
Intrinsicoid
deflection time
RIGHT BUNDLE BRANCH
BLOCK
Normal sinus rhythm, right bundle branch block
RSR’ in V1
Wide S waves in I, V6
RIGHT BUNDLE BRANCH
BLOCK
A 50/M smoker diabetic admitted for
pain.
Sinus rhythm, left bundle branch block
Pseudoinfarct pattern in V1
Monophasic R / notched R in
V6LEFT BUNDLE BRANCH
BLOCK
Myocardial ischemia and
infarction
Myocardial Injury
Criteria:1. Elevation of the origin of ST segment at its junction (J point) with the QRS
of:
a. >1.0 mm (0.10 mV) in >2 limb leads lasting at least 80 msecs
or
b. >2.0 mm (0.20 mV) in >2 precordial leads
Myocardial Injury
Criteria:2. Depression of the origin of ST segment at the J point >1.0 mm
(0.20 mV) in at least 2 leads
*ST segment deviation typically either horizontal or slope toward the direction
of T waves
Myocardial Infarction
Criteria:
1. Development of new Q waves on areas overlying
the infarct which is:
a. >0.04. secs duration
b. >25% of the height of associated R wave
After 2days Several days or months
First dayFirst and second day
Normal
ECG
Onset and first several hours
Occlusion of left descending
coronary artery
Occlusion of left circumflex
coronary artery
Occlusion of right coronary
artery
Exercise ECGs
Thank You!