心筋梗塞の心電圖(第4報) : 後壁梗塞

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In the Part I of this serial studies the author described a generatalisation of electrocardiographic findings of 35 cases of myocardial infarction, and in Part II and III, the correlationship of electrocardiographic and post-mortem findings was discussed on cases of the infarction involving the anterior wall and of the infarction involved the lateral wall of the left ventricle, respectively. In this communication, the findings in the electrocardiograms have been analyzed and correlated with the pathologic findings in 26 cases of infarction in the posterior wall of the left ventricle. Of 26 cases, 12 were men and 14 were women, with the age ranging from 60 to 96 years, except 3 cases. Of these cases, 3 had recent and 23 had healed infarctions at autopsy, but in at least 2 of the latter, the infarction was relatively fresh microscopically, and it was supposed that in at least 7 cases of the latter the electrocardiograms were obtained also in the acute stage. 1. In 10 of 26 cases, the amplitude of Q wave in Lead III was 25 per cent or more of the amplitude of the highest R wave in the standard limb leads and a Q wave was distinctly present in Lead II. In 7 of these 10 cases, in which the unipolar limb leads were also obtained, a Q wave 25 per cent or more of amplitude of the succeeding R wave was recorded in Lead _aV_F. The duration of Q wave from onset to nadir in Lead _aV_F was measured as 0.02 second or more in all of 7 cases and 0.03 second or more in 3 of these 7 cases. And the duration of the Q_aV_F, from the onset to the point of intersection of the upstroke of the succeeding R wave and the base line was measured as 0.03 second or more in all of the 7 cases, and was 0.04 second or more in 4 of the 7 cases. 2. All of the cases in which the electrocardiogram displayed an abnormal Q wave in Leads _aV_F, III and II, was accompanied by RS-T variations in these leads. None of the case in which a deep Q wave in Lead III was recorded without appearance of a Q wave in Lead II was found, except in one case, in which the elevtrocardiogram displayed an abnormal Q_<III> Q_<II> pattern at first and only an abnormal Q_<III> with absence of Q_<III> for a time and subsequently an abnormal Q wave disappeared in any lead. 3. Lead _aV_F was considered as more reliable than the standard limb leads in the diagnosis of posterior infarction. 4. In 2 cases of posterior subendocardial infarction, upward convexity of the RS-T segment on the base line and sharply inverted T wave without an abnormal Q wave were obtained in Leads II, III and _aV_F in the acute stage of infarction. It was considered that these findings were suggestive of posterior infarction. 5. In 13 cases, 50 per cent of all 26 cases, the diagnosis of posterior infarction could hardly be made, because the electrocardiogram of these cases displayed only a RS-T variation or a pattern of an uncomplicated right bundle branch block. 6. In many of the cases with infarction involving the middle third of the posterior wall, an abnormal Q wave was frequently recorded in Leads _aV_F, III and II. On the other hand, this change was seldom found in cases with infarction confined to the apical one-third or the basal one-third of the posterior wall. 7. When the electrocardiogram indicated horizontal or semihorizontal position of the heart, an abnormal Q wave in Lead _aV_F was found in only few of those cases with posterior infarction, unless a large coexistent infarction extended in the interventricular septum at the same time. 8. In posterior infarction, the differential diagnosis of transmural from subendocardial infarction was almost impossible at least from the findings of the standard and unipolar limb leads. 9. In one case of recent infarction, the right precordial leads displayed depression of the RS-T segment, which is familiar reciprocal manifestation of acute posterior infarction, and a tall R wave. Of healed infarction, high T waves in the right precordial leads were observed in 3 cases and tall R waves in these leads in one case. It was revealed that all cases in which these reciprocal changes were found in the right precordial leads, had infarction confined to the posterior wall or the posterior and lateral wall in the left ventricle at autopsy. On the other hand, these changes were not found in the right precordial leads in any of the cases in which an anterior infarction was accompanied by a posterior infarction.
社団法人日本循環器学会の論文
1955-02-20

心筋梗塞の心電圖(第4報) : 後壁梗塞

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