局部誘導法特に標準局部誘導法の臨牀的應用の研究(第6報) : ST及Tの特異變化を主題として

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According to Prof. Maekawa's "Chain-doublets" theory, polarization of the border membran plays an important role for St and T variations. Special variations of ST & T in clinical electrocardiograms, for example, those of myocardial infarction, pericarditis and digitalis effect, should be analyzed and interpreted on the consideration of polarization of epicardium or endocardium. Analysis of local lead electrocardiograms certified that local injury of epicardium causes infarction pattern and entire injury brings pericarditis pattern, and on the other hand entire endocardial injury results in digitalis pattern. (1) Myocardial Infarction : As well known facts, curves obtained in the lead point that face the epicardial surface of the infarct show usually QS pattern and elevated ST segment or inverted T wave. The former is the sign of abnormal stimulus distribution in the infarct area and the latter is the consequence of local epicardial injury. Esophageal lead electrocardiograms in the anterior infarction show depressed ST segment not only in the endocardial side (in the auricular and supra-auricular site), but in the epicardial side (in the ventricular site). This fact indicates the existence of anterior infarction indirectly and simultaneously the absence of posterior infarction. In the posterior infarction the esophageal leads may show directly infarct curves but chest leads may not usually show the indirect infarct pattern i.e. negative ST displacement. Therefore, exacter diagnosis of infarct location should be performed by means of precordial and esophageal leads as the author's cases indicate. (2) Pericarditis and epicardial Haemorrhage : Pericarditis pattern is characterized by ST, T variation and low voltage and classified to 4 phases by Holzmann. The author's cases showed pattern of III or II phase. These local lead electrocardiograms showed inversed T wave in epicardial side i.e. in chest leads and esophageal leads at the ventricular hight, and positive T wave in endocardial side i.e. in esophageal leads at the auricular and supra-auricular hight, and moreover analysis of stimulus arrival time gave always norma values. A patient with normal electro cardiographic pattern, diagnosed as subarachnoid haemorrhage, showed inversed T waves in I and precordial leads, without QRS variation and cardiac symptoms, after about 5 weeks, unexpectedly. At that time epicardial haemorrhage was suspected and after about one month she died of second subarachnoid haemarrhage. An autopsy showed scattered epicardial haemorrhage and no myocardial and endocardial lesion. the author assert that these inversed T waves without QRS variation derive from excessive repolarization of epicard after lesion and myocardial damage is secondary. (3) Digitalis electrocardiogram : ST, T depression due to digitalis effect is not clearly elucidated even now. Local lead electrocardiograms in the author's cases showed St, T depression in epicardial side and ST,T elevation in endocardial side after digitalization. So it is concluded that constant and incomplete depolarization of entire endocardium gives rise to the digitalis pattern, because polarization membrane injury due to digitalis may occur rather chiefly in the endocardium than in the epicardium.
社団法人日本循環器学会の論文
1953-11-20

局部誘導法特に標準局部誘導法の臨牀的應用の研究(第6報) : ST及Tの特異變化を主題として

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