EcgとVcgにおける右室負荷曲線とくに,慢性閉塞性肺気腫と僧帽弁口狭窄症における血行力学的所見の対比
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The mode of occurrence of the right ventricular overload in Ecg and Vcg was studied by scalar analysis of Ecg according to Ashman and Namikawa, and by Frank's leads respectively on patients with chronic obstructive emphysema, mitral stenosis and other diseases which bring about the right ventricular strain. Attention was paid to the QRSsE loop on the horizontal plane and cardiovascular dynamics in the pulmonary circuit. 1. Ecg, Vcg, right heart catheterization, pulmonary function tests and fluoroscopy of the chest (including roentgenograms and electrokymography) were performed on 50 normal subjects, 42 cases of chronic obstructive emphysema, 21 of mitral stenosis and 6 of atrial septum defect. Severity and stage of chronic obstructive emphysema were evaluated carefully in each patient. 2. P dextrocardiale (criteria by WHO in 1963) was observed in about 24 per cent of chronic obstructive emphysema in remission. Its incidence increased in number with exacerbation of the disease and ranged from 1% to 54%. Since P dextrocardiale was not always accompanied with pulmonary hypertension, P dextrocardiale itself may not signify faithfully the presence of right atrial or ventricular strain. On the other hand, within the limits of this observation, P sinistrocardiale indicated the tendency to elevation of the systolic, diastolic, mean and wedge pressures in the pulmonary artery. 3. The posterior displacement of the QRSsE loop in the horizontal plane was not closely correlated to the severity of emphysema, even when per cent 1"VC and per cent RV were duly taken into consideration. 4. In the cardiodynamics of the right ventricle, the tension period (ASZ') was more prolonged and the ejection period (ATZ'), more shortened than in normal. The ratio of ATZ': ASZ' was then more diminished. The tendency to " Druckreaktion" in sense of Blumberger was more marked in the group I-b (Fig. 2), which showed marked posterior displacement of the QRSsE loop. This group was distinguished by the auther from a shape of the QRSsE loop in the horizontal plane. During exacerbation of the disease, most cases belonged to the group I-b. They changed info the group I-a with remission. All the patients of the severity III were classified the group I-b, though this group was also seen in the severity I or II. 5. No difference in the mean pulmonary arterial pressure was noted between the group I-a and I-b. The circulatory dynamics of the group I-a showed the type of peripheral resistance (W) and volume elasticity coefficient (E'). The group I-b indicated the type of E'. 6. The findings of chest X-ray and Eky (f) could confirm a relationship to the vectorcardiographic classification in reference to the height of diaphragma, cardiopulmonary index, left median interval, extent of pulmonary arterial buldge and the ratio of height of aortic to pulmonic arch in all the groups (1-0, I-a, I-b and III) of chronic obstructive emphysema. 7. In mitral stenosis, the group I-b showed the tendency to "Druckreaktion" and the pulmonary arterial pressure was raised as high as in chronic obstructive emphysema. Displacement of the main vector of QRS to right-anterior was in parallel to the mean pulmonary arterial pressure in the group II-a and II-b. The right cardiodynamics showed no relation to the displacement. 8. "Volumereaktion" in sense of Blumberger could not always be observed on the cases of right ventricular bundle branch block. No single vectorcardiographic pattern could be regarded as characteristic for so-called incomplete R.B.B.B. diagnosed by Ecg.
- 千葉大学の論文
- 1967-01-28