Wilson法による胸部多誘導と,その臨床的意義 : とくに,Kienleのいう機能的心電曲線像について

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Regardless of Keith-Wagener's type, the line which links each transitional zone takes the course from right lower to left upper, disagreeing with the morphological septum. Irrespective of Keith-Wagener's type, the intrinsicoid deflection delays in the levogram more than in the dextrogram and in the apex more than in the base. There can not be found any significant difference between the delay in the apex and that in the levogram. The intrinsicoid deflection is particularly rapid in the area ^<+2>/F, ^<+2>/G and ^<+2>/H. (the nomenclature of the division, c. f. Fig. 1) Frequency and degree of ST-T deviation in the multiple leads are observed in K. W. III more than in K. W. I or II. As to T, there can be found no definite tendency. So far as there exists not so marked distance between the lead-spot of V_1 and that of the right ventricular margin determined by x-ray kymography, no significant difference respecting both R and ST can not be seen. Between R in V_5 and that in the spot of the left ventricular margin there can not rarely be found the difference so much as 3〜4mV. But concerning ST the significant difference beyond 0.2mV is hardly shown. There exists no significant difference between the finding in V_6 and that in its upper or lower sides. These results can be obtained irrespective of Keith-Wagener's types. B. Valvular Diseases The line which links the transitional zone each other is horizontal or ascends slowly from right lower to left upper in mitral valvular diseases and is used to hold the nearlyperpendicular course in aortic valvular diseases. In aortic valvular diseases the intrinsicoid deflection delays in levogram, especially in the vicinity of the apex and shows above 0.06" in the most of cases. In mitral valvular diseases the intrinsicoid deflection delays in the levogram more than (up to 0.01〜0.02") in the dextrogram, whereas in aortic valvular diseases this defference is estimated about 0.03''. In aortic valvular diseases the delaying rate of the apex against the base is not so marked as that of the levogram against dextrogram, however in mitral valvular diseases this relationship is not distinct. In mitral valvular diseases ST in dextrogram is almost at the equal frequency isoelectric, ascending, and descending, whereas in aortic valvular diseases there is no case with depression of ST in dextrogram. The similar tendency can be observed in base. In mitral valvular diseases T in dextrogram shows either positive or negative nearly half and half, whereas the negative T in levogram can hardly be seen. While in aortic valvular diseases the negative T can scarcely be found in dextrogram, T in levogram shows either positive or negative nearly half and half. The similar tendency can be observed between apex and base. In mitral valvular diseases V_1 is not rarely inconvinient in order to examine the electrical changes of right ventricle. The reversal finding can be said in V_5, especially as to the height of R in V_5; there can occasionally be found fhe significant (up to 1〜3 mV) difference between R in V_5 and that in the lead-spots corresponding to the left ventricular margin determined by kymography. There exists no practical difference between the finding in V_6 and that of its upper or lower sides in mitral valvular diseases, whereas in aortic valvular diseases such a definite relation can not be seen owing to the marked variation in each case. C. Myocardial Infarction Concerning the transitional zone there exists no particular tendency. The various sorts of changes occur depending upon the complication. Regardless of the localization of the infarction, the intrinsicoid deflection in levogram or apex delays more than that in dextrogram or base, however the delaying rate between levogram and apex does not show any significant difference. lateral infarction the pathological changes of Q and ST-T are used to be found in the subclavicular lead-areas. D. Coronary Insufficiency The transitional zone does not show any definite course. The delaying rate of intrinsicoid deflection in levogram against dextrogram is found more marked than that in apex against base. In the right coronary insufficiency, ST elevation in dextrogram and ST depression in levogram is usually conspicuous. The deep negative T is often observed in levogram and apex. In the upper or lower side of V_5 either ST elevation or its depression is susceptible to influences from lead-areas. Consequently in order to detect the myocardial ischemia of the left ventricle it may become necessary to examine at least in some lead-areas up or below the routine Wilson's spots. E. Bundle Branch Block The line which links the transitional zones in classical right B. B. B. and Wilson Block, except for one case with so-called incomplete R. B. B. B. bears resemblance to that seen in the mitral valvular disease. These lines observed in L. B. B. B. take the nearly perpendicular course and are similar to those which can be seen in the aortic valvular disease. Among the group of R. B. B. B. the most delayed intrinsicoid deflection can be observed at ^<-4>/J, ^<-3>/G, ^<-3>/H, ^<-2>/B, ^<-2>/I, ^<-1>/D, ^<-1>/H, 0/C, 0/D, ^<+1>/H and ^<+2>/G, whereas the most rapid intrinsicoid deflection at ^<+3>/A, ^<+4>/B, ^<+4>/C, ^<+6>/G, ^<+6>/J, ^<+7>/D, ^<+7>/E, ^<+7>/I, ^<+8>/D, ^<+9>/F, ^<+11>/C, ^<+12>/D and ^<+13>/C: the maximal difference between the former and the latter is 0.11". Among the group of L. B. B. B. this relationship is found in the reverse order; the most rapid intrinsicoid deflection can be seen at ^<+2>/C, ^<+2>/F, ^<+3>/B, ^<+4>/A and ^<+4>/D, whereas the most delayed at ^<+5>/B, ^<+6>/E, ^<+8>/K, ^<+9>/K, ^<+12>/C, ^<+12>/E and ^<+13>/C. The maximal difference between the former and the latter is 0.11" as well as that found among the R. B. B. B.. F. Chronic cor pulmonale The lines which link the transitional zones take slowly the course from right lower to left upper in chronic cor pulmonale, whereas in one case with Ayerza's disease this line leans distinctly toward the left, and inclines slowly from right lower to left upper. P in dextrogram shows either positive or negative, occationally di-, triphasic. Among the chronic cor pulmonale the intrinsicoid deflection in levogram or apex does not show any delay against that in dextrogram or base respectively. In one case with Ayerza's disease the intrinsicoid deflection in base delays somewhat (0.02〜0.04") more than that in apex. In dextrogram of chronic cor pulmonale the highest R exists at ^<+1>/D, ^<+2>/F, ^<+2>/I, ^<+3>/C, and ^<+3>/G, whereas the deepest S at ^<+1>/E, ^<+2>/D, ^<+2>/F, ^<+1>/G, ^<+1>/C and ^<+3>/A. ST in dextrogram of chronic cor pulmonale, except for Ayerza's disease, does not show any depression at every lead-spot; ST in levogram does not exhibit any characteristic pattern. Regarding both base and apex the similar tendency can be observed. T in dextrogram of chronic cor pulmonale is relatively large uprighted but it is found negative in one case with Ayerza's disease. There exists no characteristic pattern in levogram, base and apex, although the apical T is higher than the basal. One case with Ayerza's disease shows the negative T almost in all leads.
千葉大学の論文
1959-03-28

Wilson法による胸部多誘導と,その臨床的意義 : とくに,Kienleのいう機能的心電曲線像について

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