心臟の位置變化と心電圖, ベクトル心電圖の構成法的研究 : 心筋梗塞を合併せる脚ブロックに就て

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The author researched the effects of a positional change of the heart on electrocardiograms and vectorcardiograms in a bundle branch block complicated by myocardial infarctions.The heart positions examined in this report were as follows.1) A normal position (somewhat vertical with clockwise rotation).2) Two extreme vertical positions a) with marked clockwise rotation and b) with marked counterclockwise rotation.3) Two extreme horizontal positions a) with marked clockwise rotation and b) with marked counterclockwise rotation.I. In a left bundle branch block complicated by myocardial infarctions, most of the reconstructed electrocardiograms seldom showed the characteristic findings of myocardial infarction as reported by Wilson and many other authors.However, occasionally a deep S wave or an rSr' pattern was seen in Lead I, VL and V_6 as an effect of myocardial infarction in some specific conditions of the heart, i.e., when a heart having anterolateral or anteroposterior myocardial infarction is in a vertical or horizontal position with a marked clockwise rotation, or a heart having posterolateral infarction is in a vertical or horizontal position with marked counterclockwise rotation.In most of the cases of reconstructed vectorcardiograms in a left bundle branch block complicated by myocardial infarction, the characteristic findings of myocardial infarction also were not observed, but the characteristics of a left bundle branch block were able to be observed in any heart position ; however, when the infarcted area of the left ventricular wall displaced to the left as a result of positional alteration of the heart, the QRS loops were recorded displacing markedly to the right.II. The standard limb lead in a right bundle branch block complicated by a left ventricular myocardial infarction displayed the rare type of bundle branch block in all cases except those of anteroposterior, posterolateral and posterior infarction in both normal and vertical hearts with clockwise rotation.Leads VR and V_1 through V_3 showed tall late R waves and lead V_5 showed a deep S wave identical to the findings in an isolated right bundle branch block.The leads facing the infarcted area showed a Q wave, and when the position of the infarcted area was changed due to the rotation of the heart, the leads displaying an infarction Q, changed their position.The precordial leads were more sensitive, to the effects of cardiac rotation around the longitudinal axis of the heart, than the limb leads.When a heart was in counterclockwise rotation, the position of the leads which displayed the Q wave or the tall late R wave displaced to the right and when a heart was in clockwise rotation, they displaced to the left.Independently from the heart position, the initial and mid portions of the reconstructed vectorcardiograms of a right bundle branch block complicated by myocardial infarction, was displaced away from the infarcted area, but the terminal portion of these vectorcardiograms were recorded anteriorly to the right which is characteristic of an isolated right bundle branch block.
社団法人日本循環器学会の論文
1958-11-20

心臟の位置變化と心電圖, ベクトル心電圖の構成法的研究 : 心筋梗塞を合併せる脚ブロックに就て

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