本態性高血圧症,高血圧性心疾患のX線心キモグラム計測値と心電曲線,および,心・脈管力学的数値の関係
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212 cases with essential hypertension, 31 with diastolic hypertension, and 41 with hypertensive cardiac disease treated in our clinic were systematically investigated by means of x-ray kymography, electrocardiography, Blumberger-Holldack's and Wezler's method; ecg. was routinely taken in 12 leads. X-ray kymography and its measurement were carried out according to Nakamura's method (Jap. J. Int. Med., 45: 29, 1957). X-ray kymographically L, Tr, Br, Ml/Mr, Bh and FLD were estimated and particularly the thorough examination was made for existence of plateau at the left IV arc. Electrocardiographic position-type, P, PQ, QRS, ST-T and QT were investigated and the special notice was taken of the existence of ventricular overloading pattern. Cardiodynamical data were classified into three main patterns, i. e., according to Blumberger, "Druckreaktion (pressure-reaction)", "Volumenreaktion (volume-reaction)" and "Normale Reaktion (normal-reaction)". Circulatory dynamical data were also devided into three chief patterns, i. e., according to Wezler-Boger, "Minutenvolumenhochdruck (M)", "Widerstandshochdruck (W)", "Elastizitatshochdruck (E')" and various kinds of mixed forms. Results: I. As to x-ray kymography and Keith-Wagener's types in essential hypertension : 212 cases with arterial hypertension were classified by Keith-Wagener's schema, i.e., 59 cases were of I type, 122 of II and 31 of JE-IV. As the advanced degree of Keith-Wagener, the cases with abnormal cardiac measurements beyond normal range increased in number, above ail the abnormally augmented FLD was found in 50 cases of 122 with K. W. II, and in 19 cases of 31 with K. W. III-IV, whereas only in 5 cases of 59 with K. W. I. Nearly one half of cases with K. W. III-IV showed the plateau, however no such a case among K.W. I. Moreover, in the group of K. W. I the cases with prolonged L were conspicuously observed, but in the group of K. W. III-IV, the cases with abnormal Tr, Br, and Bh beyond normal range were strikingly recognized. II, Regarding the correlation between electrocardiographic and x-ray kymographic finding: A) Essential hypertension 156 cases: As the advanced degree of the abnormal deviation of ST-T, the cases with abnormally augmented FLD or with plateau increased in number. Especially as the advanced deviation of ST-T, the increasing rate of number of patients with abnormally augmented FLD, Tr and Bh, or with plateau exceeded that of number of cases with L beyond the normal range. Left position was found in 87 cases, normal position in 47 and right position in 22. The increasing rate of number of patients with abnormally augmented FLD and Tr or with plateau became greater in the group of left position than in that of normal or right position. Especially this tendency could be seen markedly in 7 cases with high degree of left position. In the group of right position the augmented FLD or Tr and the appearance of plateau were found only in minority whereas the measurements of L, Br, Bh and Ml/Mr showed no significant difference between right position and left or normal. Among the group with abnormal P the increase in FLD was seen in 29 cases of 57, while among that with normal P only in 27 of 99. The cardiac measurements were found beyond the normal range in majority of the group with prolonged PQ, especially concerning the augmentation of FLD and the appearance of plateau stood out clearly from other group. Among the group with wide QRS, the almost some tendency as that concerning PQ could be observed. Among the group with prolonged QT, the similar tendency to that regarding PQ could be found. B) Ecg and cardiac measurements in 27 essential hypertensives with diastolic pressure above 110mmHg; Most of cases with marked ST-T deviation showed the high degree of the increase in cardiac measurements. C) Ecg and cardiac measurements in 32 hypertensive cardiac disease. In comparison with essential hypertension, among the group of hypertensive cardiac disease, the cases with cardiac measurements beyond the normal range increased in number. Even four cases without abnormal deviation of ST-T showed the increased Br, Tr, Bh and FLD, and even the cases with right' position often exhibited the cardiac measurements, including FLD, beyond the normal range. But on the whole there existed not so marked correlation between electrocardiographic findings and cardiac measurements. III The relationship between cardiovascular dynamical values and x-ray kymographic measurements: This item was studied upon 166 cases with essential hypertension, 41 with hypertensive cardiac disease, and 31 with diastolic hypertension. A) 166 cases with essential hypertension were classified into 81 of W+E', 26 of W, 27 of M, 18 of E', 4 of M+W, 8 of M+E' and 2 of M+W+E'. Cardiac measurements beyond the normal range were more frequently observed in W or E' type than in M. Especially the increase in FLD, Bh andTr and theappearance of plateau were more frequently found in W type than in other types. Namely FLD beyond the normal range was observed in 15 cases of 30 among W and M+W types, in 8 cases of 26 among E' and M+E' types. Abnormally augmented L, Bh, Tr and plateau were dominantly found in W type. The frequency of Br beyond the normal range was observed equally in W type as well as in E'. Cardiodynamically 116 cases with essential hypertension were classified into 72 cases of pressure-, 35 cases of normal- and 9 cases of volume-reaction. The cardiac measurements beyond the normal limits were found more frequently in the cases with pressure-reaction than in other groups. Especially the increase in FLD was found in 44 cases of 72 with pressure-reaction, in 11 cases of 35 with normal-reaction. B) About diastolic hypertension; 31 patients were divided into 18 cases with W+E', 5 cases with W, 3 cases with M, 2 cases with E', 1 case with M+W, 1 case with M+ E', and 1 case with M+W+E'. The marked increase in each of cardiac measurements was seen in the W group. The increasing rate of all cardiac measurements, especially FLD, Bh, Br, and the appearance of plateau were found more in the diastolic hypertension than essential hypertension under 110 mmHg. The augmented FLD was found in 8 cases of 15 with pressure-reaction and in 2 cases of 3 with normal-reaction. One patient with volume-reaction in Blumberger's sense did not show any increase in FLD. C) As to hypertensive cardiac disease: Among 41 cases there were 21 patients with W+E' type whose cardiac measuements showed that the increase in Ml/Mr was found in 11 cases of 21 and nearly all other measurements exceeded also the normal range. These kinds of augmentation were more marked than in the essential hypertension. Even in M type, all cardiac measurements were beyond the normal range and the appearance of plateau was recognized. Respecting the relationsphip between cardiac measurements and cardiodynamical values in hypertensive cardiac disease : Among 17 patients with pressure-reaction in Blumberger's sense, there could be seen the remarkable increase in each of cardiac measurements except for Ml/Mr. Even among 3 patients with normal-reaction in Blumberger's sense the increase in L, Bh, Tr and the appearance of plateau were recognized in all cases, and FLD, Br exceeded the normal range in 2 cases.
- 1959-03-28