ベクトル心電圖の臨床的應用
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The author attempted to clarify the differences of the diagnoses between the Grishman's spatial vectorcardiography (G.) and its modification (Gm.), the distortion of vectorcardiography, the relation of vectorcardiography to electrocardiography and the validity of the vectorial interpretation of electrocardiography.Electrodes of the horizontal plane in the latter system were placed at the level of the fifth intercostal space on midclavicular line. Electrode C (-) was placed on the right suprascapular area.Most of the cases with normal electrocardiogram had normal vectorcardiogram by both methods, but Gm. showed more characteristic changes than G. in 3 of 35 cases. Anterior infarction was uncertain in 2 cases out of 4 in G. because the initial portion of the QRS loop did not direct posteriorly, however the initial and the midportion of the centrifugal limb in Gm. directed posteriorly sharply. In the left ventricular hypertrophy with aortic insufficiency the characteristic figure-eight-pattern was seen more frequently in the horizontal plane of Gm.. Also in the left ventricular hypertrophy due to hypertension the QRS loop in the horizontal plane displaced more posteriorly and leftward in Gm.. Initial vector of left bundle branch block directed more sharply posteriorly in Gm. than G. and the rotation of the QRS loop in the horizontal plane was figure-eight-pattern in G. but clockwise in Gm.. It was apparent that the abnormal left ventricular changes were more remarkable in Gm. than G..In the cases suggesting right ventricular hypertrophy clinically and electrocardiographically both methods of vectorcardiography were more superior than electrocardiography and Gm. was able to diagnose more frequently the mild right ventricular hypertrophy. Occassionally mild right venticular hypertrophy in G. changed to the pattern of right bundle branch block in Gm.. Posterior pip in G. was often seen in the cases of mitral valvular disease and pulmonary heart disease but posterior pip in Gm. was considered to be characteristic in pulmonary heart disease.Although these results suggested that Gm. had more distortion than G., Gm. had more superiority in the clinical application.Comparative study of the unipolar chest electrocardiogram and the scalar projection in the horizontal plane of vectorcardiogram was done. The both QRS patterns were concordant to a great extent in most cases. This was also true in the cases with myocardial infarction. The degree of concordance to the electrocardiogram was more excellent in Gm. than G.. But the concordance was poor in the cases with severe right ventricular hypertrophy.According to the above mentioned results, it was concluded that the vectorial interpretation of electrocardiogram was adequate except some cases with severe right ventricular hypertrophy and the vectorcardiogram was more useful than the electrocardiogram in clinical diagnosis. The author proposed the application of Gm. when G. failed to reveal abnormal findings distinctly.
- 社団法人日本循環器学会の論文
- 1958-11-20