Local Diagnosis of Myocardial Injury by Vectorpolyography : Part 2 Subendocardial- and Transmural Injury

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To obtain some essential knowlede regarding to the electrocardiogram in myocardial infarction, it is not only the location of the injury on a certain wa of the heart which is important but also the fact of wheather it is subepicardial, subendocardial or transmural. An attempt was made to observe the vectorpolyogram in myocardial injury which was subendocardial or transmural. (1) When the injury was produced from the endocardial surface and the subepicardial muscle layers survived, the vector of RS-T junction would be directed toward the inward normal line at the centre of the injured surface. When the transmural injury was produced from the epicardial surface, the direction of the vector of RS-T junction resembled that of the outward normal line. When the transmural injury was produced from the endocardial surface. there were two groups of experimental results as follows. In the first group the direction of the vector of RS-T junction resembled that of the outward normal line, and in the second the direction resembled that of the inward normal line. (2) When the injury was produced from the subendocardial surface, the QRS loop was deformed verp early, pulling itself toward the displaced RS-T junction. (3) It was quite difficult to explain the subendocardial injury mentioned above from the negativity theory by Fahr et al. (4) Using the renovated membrane theory by Wilson and co-workers, I expressed a simple equation which may explain from the onset of the QRS group to the displaced RS-T junction in subepicardial- and subendocardial injury. (5) I tried a model calculation by the above stated epuation in vectorcardiography when an injury was produced from the endocardial surface and indicated that the vector of the RS-T junction should be directed toward the vector sum of the moments of equivalent electrical double sheet at the surface which bounds the injured and the uninjured region as mentioned in the preceding article. The experimental results could be explained by the equation, for it might be considered that this direction of the vector sum would resemble the direction of the inward normal line at the centre of the injured surface. (6) By the equation stated above, it may be able to pursue the shift of the correlation between the RS-T deviation and the Q wave in the process of myocardial infarction. This study was made in the Toyoshima Laboratory of the Research Institute of Environmental Medicine attached to the Nagoya University. I am greatly indebted to Prof. Seizo Katsunuma, Prof. Susumu Hibino and Assist. Prof. Hideo Toyoshima for many ideas and suggestions in the pursuit of this study. I wish to thank them very much for their kindness.
社団法人日本循環器学会の論文
1952-11-20

Local Diagnosis of Myocardial Injury by Vectorpolyography : Part 2 Subendocardial- and Transmural Injury

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