右心線Eky曲線の診断学的限界,主として前肺毛細管性疾患を中心に

概要

論文の詳細を見る
The electrokymographic movements of the cardiac borders are supposed to show the intermingled changes in volume, position and rotation of the .heart action. The purpose of this paper is to elucidate the diagnostic significance of Eky mainly in precapillary lung disorders. The objects comprised 21 normal subjects, 28 cases of precapillary disorders including chronic non-specific lung disease (pulmonary emphysema, bronchial asthma and chronic bronchitis), 12 cases of postcapillary disorders including mitral valvular diseases and 25 cases of arterial hypertension, thus 86 in all. The electrokymogram (Elema Co.) was recorded at α and β sites of the right cardiac border as well as at a, b, c, d, e, f and g sites of the left cardiovascular border with ecg., peg. and carotid volume pulse wave. Chest x-ray examination, roentgenkymography, the right heart catheterization and the lung function test were also performed. I . Fig. 2 shows the most typical recording of the right cardiac border. The presystolic descent A_1-A_2 may denote the right atrial contraction. It disappeared in cases of atrial fibrillation, but reappeared with restoration of sinus rhythm as shown in Fig. 4. In cases of complete atrioventricular block the presystolic descent could be clearly seen following P wave in ecg. (Fig. 3). However, in other cases, it remained indistinct or even disappeared, showing considerable variation (Fig. 5). The systolic descent S_2-S_3 was recognized well in each case (Fig. 2〜5). Sometimes, it appeared alone (Fig 13). The diastolic descent S_6-D indicated such considerably varied occurrence just as the presystolic descent (Fig. 9). In cases of tachycardia (over 85 beats per minute), P wave in ecg. preceded increasingly the troughs of diastolic descent as seen in the left side of Fig. 10 (120 beats per minute). The right hand of Fig. 10 showed the case of 140 beats per minute. In such a tachycardic case it was difficult to decide S_6 or A_1. II. As the Q-S_2 interval and the presystolic descent were not always of diagnostic importance, the movements of the right cardiac border, including tachycardic cases, were analysed and classified into the following several types (Fig. 29). The first type showed the marked second systolic ascent S_3-S_6 and the diastolic descent with the amplitude beyond 1/5 of the total amplitude of the curve. The second type sliowed the marked second systolic ascent, but the diastolic descent with the amplitude smaller than 1/5 of the total amplitude of the curve. The third type showed the systolic descent continuing to the second heart sound (no second systolic ascent) and the trace of the diastolic descent. The fourth type showed no second systolic ascent and no diastolic descent. These four types of the curves could be further divided into two subtype A and B respectively. The A type was characterized by the presystolic descent : larger than 1/5 of the total amplitude of the curve, and the B type, by absence or only trace of the presystolic descent. Therefore, the I A type denoted the tri-phasic wave, while the I B and IV A type, the bi-phasic wave. The II B type was close to a mono-phasic wave. In the III and IV types, the influence of the right ventricle may be predominant through the systolic phase. However, the atrial factors may be involved in the III and IV A types, because the diastolic descent and the presystolic descent were recognizable in these types. The results of the classification are shown in Fig. 30. On the α-site, the III type was frequently observed, i. e. in about 50% of the cases of non-specific lung disease. In mitral valvular diseases, the IV type was most frequently observed. On the β-site, no pathognomonic types were noted, though, compared with the a-site, the second systolic ascent and diastolic descent were often better recorded. The presystolic descent (Fig. 31) was quite frequently recorded in mitral valvular diseases on the α-site, and less frequently in arterial hypertension, but rarely in the non-specific lung disease. III. A marked difference in the highest and deepest points of the curves on a and β sites was demonstrated between the non-specific lung disease (corresponding to 1 in Fig. 37) and hypertension (corresponding to 2 in Fig. 37). Furthermore, on the d-site of the fourth arch of the left cardiac border the internal movement could be observed in early diastole in the non-specific lung disease. In summary, 1. The results of the polygraphic hemodynamic analyses indicated that the electrokymographic curves of the right cardiac border seem to be a mixture of right atrial and ventricular activities in most cases, and furthermore the influences of the left heart can not be completely excluded. 2. The noticeable patterns in the precapillary lung disorders (CNLD) may be resulted from the displacement of the center of gravity of the heart following the right ventricular hypertrophy, in addition to the change in cardiac axis due to the lowered position of the diaphragm and the increase in residual air volume in the lung. These factors sometimes make it difficult to obtain the clear-cut right atrial curve under the right cardiac load in the precapillary lung disorders.
千葉大学の論文
1966-01-28

右心線Eky曲線の診断学的限界,主として前肺毛細管性疾患を中心に

スポンサーリンク

概要

著者

関連論文

スポンサーリンク