食道裂口レヘルニアの心電図に関する研究 : 特に摂食,運動負荷試験によるST変化の観察を中心として

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As a result of radio-electrocardiographic examination during and after exercise on 25 patients with hiatus hernia S-T depression in excess of 1.0mm was recorded in 7 cases before meals, and in 19 cases after meals, respectively. The electrocardiograms of 7 probands who gave S-T depression during ante-cibum exercise were also abnormal after meals. None of the 14 healthy subjects with age distribution similar to those with hiatus hernia showed S-T depression over 1.0mm. When S-T depression of more than 0.5mm on exercise test was regarded as positive, however, 22 patients with hiatus hernia gave positive result, whereas only 3 control subjects were included in this category. Accordingly, it is concluded that patients with hiatus hernia frequentry give S-T depression on exercise test before and after meals. As far as the effect of meals was concerned, S-T depression of more than 1.0mm was recorded in 7 cases on exercise before meals, and in 19 cases after meals. Since all the 7 probands with ante-cibum electrocardiographic abnormalities gave postcibum changes as well, it seems that hiatal patients give positive electrocardiographic findings on exercise test particularly often after meals. Relative to this point, MORRIS and GILBERT et al. observed a reduced coronary flow during gastric dilatation and its recovery after atropine injection in dogs. They appear to at-tribute this change to the vago-vagal reflex. From this point of view, the author administered atropine subcutaneously on 8 subjects with S-T depression over 1.0 mm on post-cibum exercise. Only 2 patients retained significantly depressed S-T segment. Moreover, the author could hardly observe a deviation of S-T segment in Trendelenburg's position during or after meals. It has been assumed that in hiatus hernia coronary arteriosclerosis as a concurrent disorder contributes to abnormal electrocardio-graphic findings, because such abnormal patterns are often demonstrable in aged patients. The author could not confirm higher incidence of S-T depression in aged group, however, when the age was studied in these 25 patients. In addition, this S-T depression could hardly be judged as a true ischemic change from the following reasons: 1) all the S-T depressions were of junctional type; 2) change in Q-T interval were negligible; 3) the number of cases showing S-T depression on post-cibum exercise test decreased after atropine injection ; 4) LEPSCKlN, DIMOND, and SANO emphasized that the type of S-T segment was more important than the degree of S-T depression. The author consider that these electrocardiographic findings should belong to the Group I (normal reaction) or Group II (harmless atypical reaction) according to DIMOND. As far as systolic blood pressure, arteriosclerotic changes of eyeground, and S-T depression are concerned, it appears that the higher the grade of arteriosclerotic changes is, the deeper the S-T segment goes down. The author wishes to consider these types as Group I or Group II according to DIMOND on the following groundes: first, the degree of S-T depression also advanced in healthy controls ac-cording to age, although to a variable extent within the normal limits; second, all the S-T depression in cases of hiatus hernia were not of ischemic but of junctional type ; third, the incidence of S-T depression and precordial discomfort or pain decreased after atropine injection; fourth, there was little change in Q-T interval. He also attributes the mechanism responsible for S-T depression to gastric dilatation during meals, particularly vago-vagal reflex due to the distention of a hiatus hernia sac together with augmented myocardial oxygen consumption resulting from exercise. Since the mechanism of ST-T changes re-mains to be elucidated, the detaile are not beyond speculation and further studies are needed.
社団法人日本循環器学会の論文
1967-01-20

食道裂口レヘルニアの心電図に関する研究 : 特に摂食,運動負荷試験によるST変化の観察を中心として

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