心筋症(Wuhrmann)のVcg分析およびHegglin症候群の知見補遺

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1. In 47 patients with Wuhrmann's myocardosis, 106 electrocardiograph^ and vectorcardiographic analyses were made with special reference to Wuhrmann-Niggli's metabolic electrocardiogram. The following results were obtained. a) In the pure dysproteinaemic myocardosis (the group M; TH/B below 1.0), a mean value and a standard deviation of SAT was 17.57±15.7μVsec. It was 13.36±11.4 μVsec in the combined myocardosis (the group K. M.). Accordingly SAT of both M. and K.M. groups were smaller than those in the normal control. b) αT^^_J, and T^_J determined were 49.2±15.6° and 27.9±11.1 μVsec respectively in the normal control. These two values were found 19.33±52.5° and 9.03±6.15 μVsec in the group M. and 3.5±57.25° and 13.84±13.2 μVsec in the group K.M. These two values in both M. and K.M. groups were reduced, showing the deviation to the counter-clockwise direction. c) No significant difference in the angle Δ of _SG to _<SA>QRS as well as the angle Δ' of _<SA>QRS to _<SA>T was found between the normal control and the diseased groups. Besides, there was not observed any definite tendency of the changes in _<SA>QRS and QR^^S_J. _SG and G^^_J in M. and K.M. groups were smaller than those in the normal control. d) The ratio of the length of T loop to its width L/W obtained by Chow's method, was found 7.17±4.18 in the normal control. The ratio was somewhat reduced and was 3.28±1.59 in the group M.; this means T loop in the group M. has a tendency to inscribe a circle. The latter finding, however, may be non-specific and can be also seen in ischaemic and hypertensive heart diseases. 2. The mucoid degeneration appeared more frequently in Wuhrmann's myocardosis than in normal control. On an average the relation between the occurrence of the mucoid degeneration and the consumption pigments remained still unclear both morphologically and statistically. The occurrence of consumption pigments may be more closely related to age than that of the mucoid degeneration. The distribution of the mucoid degeneration, on the contrary to the finding of Jansen et al., was more frequently observed in the left ventricle than in the right. 3. Among the patients who satisfied the following three conditions that were necessary for the diagnosis of Hegglin's syndrome (QT-QII>40 msec, the absolute diminution of QII time interval, and the absolute prolongation of. QT duration), some patients with hyperthyroidysm, liver cirrhosis and so on showed "hyperdynam" factors in myocardial "Kraftentfaltung" and deviated to some extent from the definition of the cardiac "insufficiency". Therefore, so far as Hegglin's syndrome is denned by the cardiac insufficiency, for example, by that of Wood (1967), the following considerations seem important to more precise discrimination of this condition. a) From the view point of the hemodynamic analysis the "hyperdynam" cases show also vasculodynamically " Entspannungsreaktion" and cardiodynamically " Normo" or "Volumenreaktion", and "hypodynam" cases show also "Anspannungsreaktion" and " Druckreaktion ". b) Recently, Hegglin has observed that when QII/Fr (QII corrected with the heart rate) and VSI/Pm (a compliance in the sense of Liithy) were plotted in a diagram, there could be the reduction of QII/Fr and augmentation of VSI/Pm in the patients "hyperdynam". On the other hand, QII/Fr was augmented and VSI/Pm was reduced in patients "hypodynam". However, according to my observation QII/Fr was reduced and VSI/Pm was augmented among the "hyperdynam" patients, whereas both QII/Fr and VSI/Pm were reduced among those "hypodynam". The causes of this disagreement were discussed in detail in this paper. 4. When epinephrine of 0.2γ/kg/min was administered intravenously for five munutes in 10 normal subjects, there could be seen a hyperdynamic Hegglin's syndrome. However, such marked change could not be seen by the use of norepinephrine, angiotension II and β-receptor blocking agents; all of these drugs resulted in relatively minor changes that were slightly beyond the normal limit.
千葉大学の論文

心筋症(Wuhrmann)のVcg分析およびHegglin症候群の知見補遺

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