構成法による心電圖の研究 心臟の位置變化の影響について
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Effects of the positional changes on electrocardiograms have been studied by many authors. However many questions still remain unsolved. The reason for this, as Goldberger says, is the difficulty of the determination of the heart position in a living human body.In this report, electrocardiographic changes of the heart under a positional change were studied by means of the reconstruction method of Toyoshima. The four heart positions examined in this article were as follows, extreme vertical and horizontal positions with marked clockwise or counterclockwise rotations respectively.Tne propagation processes of the ventricular activation used in this report were the same as those previously by the author et al. In the blocked heart, two possibilities of the spread of ventricular activation were taken into account, i.e. the anterior wall of the ventricle in the blocked side is activated earlier than the posterior wall of the same ventricle ; the posterior wall of the ventricle in the blocked side is activated earlier than the anterior wall.Of course it is questionable to assume that the heart always takes the same configuration as described in this report and does not show any deformation despite the occurrence of a positional change. However, by making the above assumption one may easily recognize the effect of a positional change without any other factors being involved.The following results were common to both normal and bundle branch blocks.1. The effect of the rotation around the long axis of the heart to the electrocardiogram was larger than that around the antero-posterior axis.2. In a vertical heart, the rotation around the long axis caused a displacement to the right or left of the transitional zone depending upon the counterclockwise or clockwise rotation, but in a horizontal heart, there was no definite change.3. Even in a heart with same position and form, the configuration of the QRS complex and the position of the transitional zone were variable depending upon the pattern of the postulated propagation process of the ventricular activation.4. The results of the reconstruction method were confirmed experimentally in dogs by adjusting the lead-points of the limb leads as analogously as possible to human limb leads.In a normal heart, the axis deviation of the electrical heart axis corresponded with that of an anatomical heart axis when the heart was vertical with marked clockwise rotation, or horizontal with marked counterclockwise rotation. On the other hand these axes did not corresponded with each other when the heart was vertical with marked counterclockwise rotation or horizontal with marked clockwise rotation.In a markedly horizontal heart, the QRS complexes in leads V_5 and V_6 did not always necessarily conform to the qR or Rs pattern, but occasionally to the rS pattern. This unexpected pattern is likely to appear as a result of a rather marked upward displacement of the apex, when the lead-points V_5 and V_6 view the heart from the postero-inferior aspect.In a left bundle branch block, a typical RI and SIII pattern type was observed in hearts having marked counterclockwise rotation rather than in hearts having vertical or horizontal displacements. Even when there was marked clockwise rotation in hearts assuming a horizontal position, the S wave in lead III was not as deep and the R wave in lead I was not as large and both waves indicated the decline of a common type of left bundle branch block. The concordant pattern of a left bundle branch block only could be observed in a heart in the vertical position, especially when the anterior wall of the left ventricle was activated earlier than the posterior wall.In a right bundle branch block, the rare type of an bundle branch block could be observed when a marked counterclockwise rotation of the heart was present. The usual type of Wilson block was seen in a normal or vertical position having clockwise rotation and also, according to circumstances, in hearts in a horizontal position with marked clockwise rotation.
- 社団法人日本循環器学会の論文
- 1958-11-20
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- 構成法による心電圖の研究 心臟の位置變化の影響について