memo ¿´ÅÅ¿Þ
ÏÀʸµ¿ÌäÅÀmemoeQ
ά¸ìDurrerĴΧRÇȤÈTÇÈ
Ǿ»½ýecgPRRAH
LAELAHLPHBAH
QRSLVHRVHtransiton
OsbornIVCDMATWAT
QTclong_QTShort_QTST
STÊѲ½final¿´Ë¼¿ÇÃÇÀܹçÉôĴΧ
˼¼¼²òÎ¥¹âV1R±¦µÓ¥Ö¥í¥Ã¥¯º¸µÓ¥Ö¥í¥Ã¥¯
º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯º¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯¹âTÇȵðÂç±¢À­TÇÈ
¿´ÈîÂç¤È¿´³ÈÄ¥º¸¼¼ÈîÂ籦¼¼ÈîÂçBER
ÈóQÇȹ¼ºÉ°Û¾ïQÇÈAMIÁ°ÊÉÃæ³Ö¹¼ºÉ
Á°Êɹ¼ºÉÁ°ÊÉÃæ³Ö¦Êɹ¼ºÉ¹â°Ì¦Êɹ¼ºÉ²¼Êɹ¼ºÉ
¸åÊɹ¼ºÉ±¦¼¼¹¼ºÉ¿´ÀíÉô¹¼ºÉ¹¼ºÉ¡Ü¥Ö¥í¥Ã¥¯
RÇȤÎÁý¹âÉÔÎÉ¿´¼¼áî¿´¶Ú¾É³ÈÄ¥·¿¿´¶Ú¾É
ÈîÂç·¿¿´¶Ú¾ÉWPWBlock¤Ç¤ÎTÇÈPE(ÇÙ¹¼ºÉ)
´§Æ°Ì®´§ÀÅ̮ƶĴΧÉÔÀ°Ì®°Ü¹ÔÂÓ
¥ß¥é¡¼¥¤¥á¡¼¥¸¥¹¥È¥ì¥¤¥óTÇȾ®¤µ¤ÊV1¾®¤µ¤ÊV6
V6¤ÎQS¥Ñ¥¿¡¼¥óÊѹÔÅÁƳVT¤ÈSVTAVNRT
AIVRGEGE100GE200
GE300¥¤¥ª¥ó¥Á¥ã¥Í¥ëÁíÏÀNa¥Á¥ã¥Í¥ëK¥Á¥ã¥Í¥ë
IKurIKrIKsIK1
TWAUÇȥǥ륿ÇÈJÇÈ
QT±äĹ¾É¸õ·²Áá´üºÆʬ¶Ë¾É¸õ·²Wellens¾É¸õ·²Brugada
ÊèÀÐÍÍÇÈ·Á¹âCa·ì¾É¿´Â¡²ò˶Luna¤Î¹Í¤¨Êý
¥¤¥ª¥ó¥Á¥ã¥Í¥ë¥Á¥ã¥Í¥ëÌ©ÅÙ

¸µ¤ËÌá¤ë¡¥
GE #71, GE #260
ÆÍÁ³»à¤Î2013ǯ°äÅÁ»Ò²òÀÏ
 Utah ECG outline
100 ECGs in the Fast Lane 
ECG library A-Z 
index.php
Google
³Ø²ñȽÄê´ð½à
minesota2005.pdf
ÆüËÜ¿´Åſ޳زñÍѸ콸
final.pdf
Luna Basicd ECG
code1.pdf
ECG.pdf
Channel.pdf

II < 0 ¤Ê¤é -30¡ë°Ê²¼
III <0 ¤Ê¤é 30¡ë°Ê²¼


ÏÀʸÌܼ¡¤ËÌá¤ë¡£
¡ù ÏÀʸÂê̾¡§ÂÎɽ¿´Åſޤο·¤·¤¤²ò¼á
µ¿ÌäÅÀÌܼ¡¤ËÌá¤ë¡£
2019ǯ 7·î 10Æü ¿åÍËÆü 08:26:05 JST ¡ù ¿´¶Ú¹¼ºÉ¤Ç¤Î°Û¾ïQÇȤÎȯÀ¸Íýͳ¤¬¤ï¤«¤é¤Ê¤¤¡¥ 2019ǯ 5·î 24Æü ¶âÍËÆü 08:12:33 JST ¡ù R¶Ë¤ÈF¶Ë¤ÎÅŰ̺¹¤ÇECG¤¬ºîÀ®¤Ç¤­¤ë¤Î¤Ê¤é¡¤IͶƳ¤è¤êRÇȤÎÅṲ̋ò °ú¤­»»¤¹¤ì¤ÐL¶Ë¤ÎÅṲ̋¬»»½Ð½ÐÍè¤ë¤Ï¤º¤Ç¤¢¤ë¡¥¤½¤ì¤ÏR¶Ë¤ÈF¶Ë¤Î °ìÄê¤Îº®¹çÈæΨ¤Çɽ¸½¤Ç¤­¤ë¤À¤í¤¦¡¥ ¡ù ¸åÊɹ¼ºÉ¤¬È¯À¸¤¹¤ë¤È¡¤V1¤äV2¤ÎRÇȤ¬Áý¹â¡¤STÄã²¼¡¢¾å¸þ¤­¤ÎÂоΤÊTÇȤˤʤ롥 12 Lead ECG p. 472. ECG 15-28 ECG 15-29 ¸åÊɹ¼ºÉ¤Î¥ß¥é¡¼¥¤¥á¡¼¥¸¤ÇSTÄã²¼¡¤¾å¸þ¤­TÇȤÏfinal p.52¤Ç²òÀ⤵¤ì¤Æ¤¤¤ë¡¥ ¤·¤«¤·¡¤V1-2¤ÎRÇȤÏÀâÌÀ¤¬¤Ç¤­¤Ê¤¤¡¥ 2019ǯ 5·î 23Æü ÌÚÍËÆü 08:12:33 JST ¡ù ¹âÄã¥Þ¥°¥Í¥·¥¦¥à·ì¾É ¡ù ¹âÄ㥫¥ë¥·¥¦¥à·ì¾É ¡ù ¿´³°Ëì±ê¤Ç¤ÎPRÄã²¼ ¡ù Ä㥫¥ê¥¦¥à·ì¾É¤Ç¤ÎUÇȤÈIKr¥Á¥ã¥Í¥ë ¡ù ¥¸¥®¥¿¥ê¥¹¤Ë¤è¤ë³èÆ°ÅÅ°Ì2Áê¤ÎÄã²¼¤ÈIK(Ca)¤È¤Î´Ø·¸ ¡ù UÇȤΥᥫ¥Ë¥º¥à¤ÎʬÀÏ 2019ǯ 9·î 23Æü ·îÍËÆü 23:28:33 JST °Û¾ïQÇȤÎȯÀ¸¥á¥«¥Ë¥º¥à¤ò½ñ¤­Ä¾¤¹¤³¤È¡¥ ¿´ÆâËì²¼¹¼ºÉ¤ÏGE #293¤òÎã¤Ë¤¢¤²¤ë»ö¡¥ final pp.63¤ò½ñ¤­Ä¾¤¹¤³¤È¡¥°Û¾ïQÇȤˤĤ¤¤ÆÈîÂçÀ­¿´¶Ú¾É¤òÎã¤Ë¤·¤Æ¤â¤è¤¤¡¥
memoeÌܼ¡¤ËÌá¤ë¡£
¥Ò¥Èξ¿´¼¼¶Úæʬ¶Ë¤Î»þ´Ö·Ð²á: fainal.pdf¤Îp.25 Block¤Ç¤ÎTÇȤÎÊѲ½ p. 409 º¸¼¼ÈîÂ硧R V5 or V6 + S V1 >35mm; R in aVL >11mm QT 0.3¡Á0.45 QTC 0.34¡Á0.425 111 µ­Ï¿ÉÔÎÉ 112 ÅŶˤΤĤ±°ã¤¤ 121 È¿»þ·×²óž (V1¤ÇRs¡¤V6¤Çhigh R)transition¤¬v3°Ê²¼ 122 »þ·×²óž (V1¤Çhigh R¡¤ V6¤Çhigh S) transition¤¬v4°Ê¾å 131 ÄãÅÅ°Ì(»Í»èͶƳ) 141 QT±äĹ c 142 QTû½Ì c 151 ±¦¶»¿´ 161 ¹â¤¤TÇÈ 171 ST¾å¾º 172 STÄã²¼ 174 ÅÁƳÃÙ±ä (±¦¼¼¤òÉÕ¤±¤ë) 201 ÉÔÄê¼´ 202 ·ÚÅ٤ʺ¸¼´ÊÐ°Ì 203 ±¦¼´ÊÐ°Ì 90¡ë°Ê¾å 204 ¹âÅ٤ʱ¦¼´ÊÐ°Ì 205 º¸¼´ÊÑ°Ì -30¡ë°Ê²¼ 206 S1S2S3 300 ±¦¼¼¹âÅÅ°Ì V1 rÇÈ>5mm¤ÇR/s >1 c 301 º¸¼¼¹âÅÅ°Ì c STÊѲ½¤Î¾ì¹ç d 303 ·ÚÅ٤ʱ¦¼¼ÈîÂç¡¥ 304 º¸¼¼ÈîÂç¤Îµ¿¤¤ 306 ±¦¼¼ÈîÂç¤Îµ¿¤¤ (S1Q3) 307 º¸Ë¼Éé²Ù b 308 ±¦Ë¼Éé²Ù b 315 º¸¼¼ÈîÂç 401 P-Rû½Ì 410 P-R±äĹ 402 WPW¾É¸õ·² 411 IÅÙ˼¼¼¥Ö¥í¥Ã¥¯ c 412 IIÅÙ˼¼¼¥Ö¥í¥Ã¥¯(Wenckebach) d 500 ¥Ú¡¼¥¹¥á¡¼¥«¡¼°ÜÆ° 501 ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯ b 502 ¿´¼¼Æâ¥Ö¥í¥Ã¥¯ 503 ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯ b V1,V2¤Î¿¼¤¤rSÇÈ¡¤I, aVL, V5, V6¤ÇqÇȤ¬¤Ê¤¤¡¥QRS¤Ï0.12ÉðÊÆâ 504 ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯ c 505 ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯ d 511 º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯ <-30¡ëavL¤ÇRÇÈ¡¤III¤ÇSÇÈ¡¥c 512 º¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯ >90¡ë aVL¤ÇQÇÈ¡¤I¤ÇSÇÈ¡¥c 521 ξµÓ¥Ö¥í¥Ã¥¯ d 611 Ê¿ÄãT c 621 ±¢À­T (5mm°Ê²¼ c¡¨¤½¤ì°Ê¾å d) 622 ±¢À­U 623 ÆóÁêÀ­U 624 ÈóÆðÛŪTÇÈ°Û¾ï c 632 ·ÚÅÙST¡¼T°Û¾ï 633 ST¡¼T°Û¾ï 701 RÇȤÎÁý¹âÉÔÎÉ 712 ¿´¶Úµõ·ìµ¿¤¤ 721 ¿´ÆâËì²¼¹¼ºÉ 731 Á°Êɹ¼ºÉ¤Îµ¿¤¤ 732 ¦Êɹ¼ºÉ¤Îµ¿¤¤ 733 ²¼Êɹ¼ºÉ¤Îµ¿¤¤ 734 Á°ÊÉÃæ³Ö¹¼ºÉ¤Îµ¿¤¤ 735 ¹â°Ì¸åÊɹ¼ºÉorÈ¿»þ·×²óžµ¿¤¤ 742 ¦Êɹ¼ºÉ¤Î²ÄǽÀ­ 743 ²¼Êɹ¼ºÉ¤Î²ÄǽÀ­ 744 Á°ÊÉÃæ³Ö¹¼ºÉ¤Î²ÄǽÀ­ 745 ¹â°Ì¸åÊɹ¼ºÉ¤Î²ÄǽÀ­ 752 ¦Êɹ¼ºÉ 753 ²¼Êɹ¼ºÉ 754 Á°ÊÉÃæ³Ö¹¼ºÉ 774 ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ 801 ´§¾õÀÅ̮ƶĴΧ 802 º¸Ë¼Ä´Î§¤Îµ¿¤¤ 803 °Û½êÀ­¾å¼¼À­Ä´Î§ 811 ƶÀ­½ùÌ® 45-49 A, 40-44 C 812 ƶÀ­ÉÑÌ® 101 > D2 813 ÉÑÌ® 101 > D2 814 ½ùÌ® 45-49 A, 40-44 C 821 ƶÀ­ÉÔÀ°Ì® 841 ¾å¼¼À­´ü³°¼ý½Ì 842 ¿´¼¼À­´ü³°¼ý½Ì 843 ¾å¼¼À­»°ÃÊÌ® 844 ¿´¼¼À­»°ÃÊÌ® 845 ¾å¼¼´ü³°¼ý½Ì(º¢È¯) 846 ¿´¼¼´ü³°¼ý½Ì(º¢È¯) 847 ¾å¼¼À­ÆóÃÊÌ® 848 ¿´¼¼À­ÆóÃÊÌ® 871 ¿´Ë¼ºÙÆ° d 872 ¿´Ë¼ÁÆÆ° d 881 ³ÎÄê¤Ç¤­¤Ê¤¤ÉÔÀ°Ì® 883 ÇÙÀ­P 998 ¥Ö¥ë¥¬¥À·¿ (9-2-3, 9-2-4) ¿´Ë¼¿ÇÃÇ final p.79 IMG_20170912_0005.pdf Brugada final p.70 ? Brugada¤Î¶»ÉôͶƳ¤ËSÇȤϸºß¤¹¤ë¤«¡© Åú¤¨¡§Â¸ºß¤·¤Æ¤â¤è¤¤¡£
QÌܼ¡¤ËÌá¤ë¡£
GE¤Î°Û¾ïQÇÈ #185, #183, #189, #190(WPW)
ά¸ìÌܼ¡¤ËÌá¤ë¡£
12-Lead ECG aberrant intraventricular conduction ¿´¼¼ÆâÊѹÔÅÁƳ ACS Acute coronary syndrome AT Atrial Tachycardia AVNRT ˼¼¼·ëÀá¥ê¥¨¥ó¥È¥ê¡¼À­ÉÑÇï BER Benign Early Repolarisation (ÎÉÀ­Áá´üºÆʬ¶Ë) CABG coronary artery bypass grafting ´§Æ°Ì®¥Ð¥¤¥Ñ¥¹½Ñ CAD coronary artery disease DCM dilated cardiomyopathy (³ÈÄ¥·¿¿´¶Ú¾É) DPW Æó½ÅÅÁƳϩ(Æó½Å˼¼¼·ëÀáÅÁƳϩ) FPW Fast Pathway ®ÅÁƳϩ HCM hypertrophic cardiomyopathy (³ÈÄ¥·¿¿´¶Ú¾É) IACD intraatorial conduction delay, »Í»èͶƳ¤ÎPÇȤ¬Àµ¾ï¤Ç¶»ÉôͶƳ¤Ç RAE¡¤LAE¤Î¾õÂÖ¤ò¤¤¤¦¡¥ ID intrinsicoid deflection final p.82 12 Lead ¤Ç¤Ï´ðÀþ¤«¤éRÇȤÎĺÅÀ¤Þ¤Ç¤Î»þ´Ö(VAT)¤ò¼¨¤¹¡¥¤Þ¤¿¡¤ ĺÅÀ¤«¤é´ðÀþ¤Þ¤Ç¤Î»þ´Ö¤Ïlate intrinsicodd deflection¤È¤¤¤¦¡¥ ecg 11-10, GE #298. ID¤¬È¯À¸¤¹¤ëÍýͳ¤Ï¿´³°Ë즿´¶Ú¤Îæʬ¶Ë»þ´Ö¤ÎÃÙ±ä¤Î¤¿¤á¡¥ VAT¤ÎÃÙ±ä¤Ï¿´ÆâË즿´¶Ú¤Îæʬ¶Ë»þ´Ö¤ÎÃÙ±ä¤Î¤¿¤á¡¥ idioventricalr rhythm ¿´¼¼¸ÇͭĴΧ accelated idioventricalr rhythm Â¥¿ÊÀ­¿´¼¼ÈøͭĴΧ IRBBB incomplete right bundle brach block¡¤V1¤ÇRSR'¡¤qR'¡¥qR¤È¤Ï½ñ¤«¤Ê¤¤¡¥ R:S ratio¤Ïɬ¤ºÂ礭¤¯¤Ê¤ë¡¥ intrinsicoid deflection RÇȤÎΩ¾å¤ê¤«¤éĺÅÀ¤Þ¤Ç¤Î»þ´Ö¤ò¼¨¤¹¡¥VAT¤ÈƱ¤¸¡¥p.45, final p.82. late intrinsicoid deflection¤ÏĺÅÀ¤«¤é´ðÀþ¤ËÌá¤ë¤Þ¤Ç¤Î»þ´Ö¡¥ irregularly irregular ÀäÂÐŪÉÔÀ°Ì® wandering atrial pacemaker, multifocal atrial tachycardia, atrial fibrillation. IVCD intraventricular conduction delay, 94, 141,198, 289-292, 504-509, 522, 621, 626, 657, QRS¤Ç¥®¥¶¥®¥¶¤Ë¤Ê¤ë¡¥ 236, 14-8 ¹âK·ì¾É¤ÇQRSÉý¤¬0.12Éðʾå¤Ë±ä¤Ó¤ë¡¥ isoelectric R/SÈ椬1¤ò°ÕÌ£¤¹¤ë¡¥ IWMI inferior wall myocardial infarction p.354 CHF congestive heart failure ESRD end stage renal disease IWMI inferior wall miocardial infaruction ECG 13-31 (p.308 S1Q3¤Ç¤¢¤ë¤¬¡¤IIIͶƳ¤ÇJÅÀ¾å¾º¡¤ aVL¤ÇJÅÀÄã²¼(¥ß¥é¡¼¥¤¥á¡¼¥¸)¡¥ LAA Left Atrial Abnormality. LAD Left axis deviation¡¤º¸¼´Êа̡¤(²¼Êɹ¼ºÉ¤Ç¤ÏII,III,aVF¤ËQS¤È¤Ê¤ë¤«¤é¡¤ ÅöÁ³LAD¤Ç¤¢¤ë¡¥LAFB¤È¤Ï¿ÇÃǤ·¤Ê¤¤¡¥ LAE Left atrial enlargement º¸Ë¼ÈîÂç¤ÏV1¤Ç2ÁêÀ­¤Ç¹â¤µ¡ßÉý¤¬0.3mmsec°Ê¾å¡¥ LAFB Left anterior fascicular block¡¤º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯¡¥ LAH LAH¤Ë¤ÏrÇȤ¬Â¸ºß¤¹¤ë¡¥¤Ê¤±¤ì¤Ð²¼Êɹ¼ºÉ¡¥V6¤ËSÇȤ¬Â¸ºß¤¹¤ë¡¥p.296 Left anterior hemiblock4 LBB º¸µÓ¥Ö¥í¥Ã¥¯¤Ë¤ÏV1¤ÇrÇȤ¬Â¸ºß¤¹¤ë¡¥Ìµ¤±¤ì¤ÐÁ°ÊÉÃæ³Ö¹¼ºÉ¤òȼ¤¦¡¥ left main stem º¸¼ç´´Éô Á°²¼¹Ô»Þ¤È²óÀû»Þ¤¬Ê¬´ô¤¹¤ëÁ°¤Î·ì´É¡¥ LPFB left posterior fascicular block Àè¤Ëº¸¼¼Á°Êɤ¬¶½Ê³¤¹¤ë¤¿¤á¾®¤µ¤Êº¸¾å¸þ¤­¤Î¶½Ê³¤¬¤¢¤ê¡¤¤½¤Î¸å±¦²¼¤Ë Â礭¤¯¶½Ê³¤¹¤ë¡¥¤·¤¿¤¬¤Ã¤Æ¡¤II, III, aVF¤ÎTÇȤϵÕž(flip)¤¹¤ë¡¥ axis 90¡ë°Ê¾å¡¤I¡¤aVLͶƳ¤ÇrSÇÈ¡¤III¡¤aVFͶƳ¤ÇqRÇÈ¡¥ V1ͶƳ¤ËrÇȤ¬¤Ê¤¤¤³¤È¤â¤¢¤ë(p.303)¡¥ RAE±¦Ë¼³ÈÂç¤ÈRVH±¦¼¼ÈîÂç¤ò½ü³°¤¹¤ë¤³¤È¡¥ ºÇ¤â°ìÈÌŪ¤Ê±¦¼´ÊѰ̤ϱ¦¼¼ÈîÂç¤Ç¤¢¤ë¡¥ º¸¼¼Â¦Êɹ¼ºÉ¤â±¦¼´ÊѰ̤ˤʤ롥 ¸å»Þ¤ÏÉý¤¬¹­¤¯Ê¬ÉÛ¤·¡¤¥Ö¥í¥Ã¥¯¤Ïµ©(200¡Á3000Îã¤Ë1ÅÙ¡¤p.301)¡¥ LPH left posterior hemiblock (LPFB¤ÈƱ¤¸)¡¥ MAT Multifocal atrial tachycardia NSTEMI non-ST-segment elevation myocardial infarction NSSTWC non spacificd ST wave change P-mitrale ÁÎ˼À­P¡¤I,IIͶƳ¤Ç0.12sec(3mm)°Ê¾å¤ÎPÇȤÇMÍͤΥΥåÁ¤òȼ¤¦¡¥ Æó¤Ä¤Î¤³¤Ö(hump)¤ÎĺÅÀ¤Î´Ö³Ö¤Ï0.04sec(1mm)¤¬É¬Íס¥ P-pulmonale ÇÙÀ­P¡¤IIͶƳ¤Ç2.5mm°Ê¾å¤Î¹â¤µ¡¥ PRP poor R wave progression, »þ·×²óž¤Ç¤â¤½¤Î¤è¤¦¤Ë¿ÇÃǤ¹¤ë¡¥GE #298. PRP¤ÏV3-6¤ÎR/SÈæ¤ÎÁý²Ã¤¬¾¯¤Ê¤¤¤³¤È°ÕÌ£¤¹¤ë¡¥Axis <-30¤Ê¤é¾å¸þ¤­ ¥Ù¥¯¥È¥ë¤À¤«¤éV3-5¤ÎRÇȤÏÁý²Ã¤·¤Ê¤¤¡¥LAFB¤ÏPRP¤Ë¤Ê¤ë¡¥ PSVT ȯºîÀ­¾å¼¼ÉÑÇAVNRT¤¬ºÇ¤â¿¤¤¡¥final p.125 RAA right atrial abnormality RAD right axis deviation RAE right atrial enlargement RFCA ¹â¼þÇÈ¥«¥Æ¡¼¥Æ¥ë¥¢¥Ö¥ì¡¼¥·¥ç¥ó RVH right ventricular hypertorophy LVH¤òȼ¤¦RVH¤ÏV1¤ÇRÇȤòȼ¤ï¤Ê¤¤(P. 362, ECG 14-25)¡¥ S1Q3T3 right ventricular strain pattern (p.85, 302, 359) ¤³¤Î¥Ñ¥¿¡¼¥ó¤ÏLPH¤ÈPE¤ÈƱ¤¸¤Ç¸½ÉÂÎò¤Ç¤É¤Á¤é¤«È½ÃǤ¹¤ë¡¥ RVH¤Ç¤âƱ¤¸¥Ñ¥¿¡¼¥ó¤Ë¤Ê¤ë(P.305, ECG13-30)¡¥ septal Q aVL¤ÎQÇÈ¡¤septal Q¤¬¤¢¤ë¤ÈLBBB¤¬ÈÝÄê¤Ç¤­¤ë¡¥GE #243 Ãæ³Ö¤Ç¤Îº¸µÓ¤«¤é±¦µÓ¤Ë¸þ¤«¤¦rÇȤÏaVL¤ÇqÇȤ˸«¤¨¤ë¡¥ LBBB¤Ç¤Ï¤½¤ÎqÇȤ¬Â¸ºß¤·¤Ê¤¤¤È¹Í¤¨¤ì¤Ð¾å¤Îʸ¾Ï¤È¹çÅÀ¤¬¤¤¤¯¡¥ ⤷¡¤12 Lead¤Ç¤ÏV1¤ÎrÇȤ¬Â¸ºß¤·¤Æ¤âLBBB¤È¿ÇÃǤ·¤Æ¤¤¤ë¡¥ º¸µÓÉÔ´°Á´¥Ö¥í¥Ã¥¯(ILBBB)¤Ç¤ÏI, aVL¤ËqÇȤ¬Ìµ¤¯¡¤RÇȤÎÁý¹âÉÔÎÉ¡¥ SPW Slow Pathway ÃÙÅÁƳϩ ST Sinus Tachycardia STEMI ST-elevation myocardial infarction¡¤ST¾å¾º·¿¿´¶Ú¹¼ºÉ strain T waves RVH¤Ç¤Ï¥Ô¥ó¤ÈÄ¥¤Ã¤¿°ÕÌ£¤Ç¿åÊ¿¤ÊST¥»¥°¥á¥ó¥È¤ò¤¤¤¦¡¥ LVH¤Ç¤ÏV4¤«¤éV6¤Þ¤Ç¡¤RÇȤËÂФ·¤ÆST depression, Concave Downward, Flipped Asynmetric T wave¡¥ V1¤«¤éV3¤Þ¤Ç¡¤SÇȤËÂФ·¤ÆConcave Upard, ST Elevation Upright Asynmetric T wave (p. 363)¡¥ three-vessel 3»Þ(Á°²¼¹Ô»Þ¡¢²óÀû»Þ¡¢±¦´§Æ°Ì®)¤ò¼¨¤¹¡¥ Tp(Ta) PÇȤκÆʬ¶ËTÇÈ UA Unstable angina uncertain age ȯ¾ÉÉÔÌÀ¤Î upward convex ¾å¤ËÆÌ¡¤(ST¥»¥°¥á¥ó¥È¤Ç¤Îɽµ­) concavity¤Ï±ú¤ò¼¨¤¹¡¥ Ä̾ï¤ÎST¥»¥°¥á¥ó¥È¤Ïupward concavity¤Ç¤¢¤ë¡¥ V1¤ÇRÇÈ RVH¡¤RBBB¡¤¸åÊɹ¼ºÉ¡¤WPW type A, »Ò¶¡¤È¼ãǯ ¥¹¥È¥ì¥¤¥ó¤ò´Þ¤à¿´ÅÅ¿Þ¥µ¥Þ¥ê¡¼ VAT ventricular activation time final p.82. ¿´ÆâËì¦æʬ¶Ë»þ´Ö¤ò¼¨¤¹¡¥¿´ÈîÂç¤Ç¤³¤ÎVAT¤¬Ãٱ䤹¤ë¡¥ID¤âÃٱ䤹¤ë¡¥ VTach ventricular Tachycardia ¿´¼¼ÉÑÇï ¿´Ë¼Ä´Î§¤È¤Î²òÎ¥¤Ïdissociated atrial rate¤È¤¤¤¦¡¥p. 75 WAP wandering atrial pacemaker, ecg 9-8
DurrerÌܼ¡¤ËÌá¤ë¡£
Durrer.png
ĴΧÌܼ¡¤ËÌá¤ë¡£
Junctional 40¡Á60 BPM Accelerated Junctional 60¡Á80 BPM Idioventricular 20¡Á40 BPM (¿´¼¼¸ÇͭĴΧ) Accelerated Idioventricular 40¡Á100 BPM Ventriculara Tachycardia 100¡Á200 BPM AV dissociation ˼¼¼²òÎ¥ ¿´Ë¼¤È¿´¼¼Ä´Î§¤Ï3¡ë¤Î¥Ö¥í¥Ã¥¯¤Ç¤¢¤ë¤¬¿´Çï¿ô¤ÏƱ¤¸¡¥
RÇȤÈTÇÈÌܼ¡¤ËÌá¤ë¡£
BB p.55 Fig 6.2¤Çñ°ì¿´¶Ú¤Îæʬ¶Ë²áÄø¡¤6.3¤ÇºÆʬ¶Ë²áÄø¤ò¼¨¤¹¡¥ ¿´¶Ú¤¬Ã¦Ê¬¶Ë²áÄø¤Ç¡Ü¥¹¥Ñ¥¤¥¯¤È¡Ý¥¹¥Ñ¥¤¥¯¤¬Æ±»þ¤Ëµ­Ï¿¤µ¤ì¤Æ¤¤¤ë¡¥ Ʊ¤¸Êý¸þ¤Ëæʬ¶Ë¤ÈºÆʬ¶Ë¤¬¤·¤ç¤¦¤¸¤ë¤Ê¤éRÇȤÈTÇȤﶤì¤ÏµÕ¤Ë¤Ê¤ë¡¥ ¤³¤ÎÀâÌÀ¤ÇFig 6.4¤Ë¿´Ë¼¤Îæʬ¶Ë¤ÈºÆʬ¶Ë¤òÀâÌÀ¤·¤Æ¤¤¤ë¡¥ ½¾¤Ã¤ÆPÇȤÈTaÇȤﶤì¤ÏµÕ¤Ë¤Ê¤ë¡¥ ¿´¼¼¤Ç¤ÏFig 6.11A¤Ëæʬ¶Ë¡¤6.11B¤ËµÕÊý¸þ¤ÎºÆʬ¶Ë¤ò¤·¤á¤·¤Æ¤¤¤ë¤«¤é RÇȤÈTÇȤﶤì¤ÏƱ¤¸¤Ë¤Ê¤ë¡¥ ¤³¤Î¾Ï¤Ç¤ÏTÇȤεÕž¤Ïµ­½Ò¤µ¤ì¤Æ¤¤¤Ê¤¤¡¥
Ǿ»½ýÌܼ¡¤ËÌá¤ë¡£
SAH, ǾÆâ½Ð·ì¤Ê¤É¤Ç¤Ï¿¼¤¤µÕžTÇȤ¬¸½¤ì¤ë¡¥¸¶°ø¤Ï¸ò´¶¿À·Ð¤ÎÉÔÁ´¤Ë¤è¤ë¡¥ Essentials of Learning ... p. 138. ±¦¸ò´¶¿À·Ð¤Ïº¸¼¼Á°Êɤò»ÙÇÛ¡¤º¸¸ò´¶¿À·Ð¤Ïº¸¼¼¸åÊɤò»ÙÇÛ¤¹¤ë¡¥Î¾Â¦¤Î À±¾õ¿À·ÐÀá¤ò¾ÆµÑ¡¤¥Ö¥í¥Ã¥¯¤¹¤ë¤³¤È¤Ë¤è¤ê¿´ÅÅ¿Þ¤ËÊѲ½¤òÍ褹¡¥ nejmicm020416.pdf 19ºÍÃËÀ­¡¤Îû´¤¥Ö¥í¥Ã¥¯¤Çº¸Â¦Æ¬Éô¤Î»½ý¡¤48»þ´Ö¸å¤Ë¶¯ÅÙ¤ËST¾å¾º¤È STÄã²¼¤ò¸«¤¿¤¬¡¤·ì±Õ¸¡ºº¤Ç¤ÏÀµ¾ï¡¤¼¡¤ÎÆü¤Ë¤Ï°Û¾ï¤¬²þÁ±¤·¤¿¡¥ SAH¤Ë¤è¤ë¿´ÅÅ¿ÞÊѲ½ÁíÀâ 12471_2010_Article_49.pdf
ecgÌܼ¡¤ËÌá¤ë¡£
9-1 biphasic P wave¡¤S1Q3T3¡¤º¸¼´Êа̡¤V1¤Ç¹âR¡¤LVH¤«IRBBB¤Î²ÄǽÀ­¡¥ PFB¤Ï¤Ê¤¤¡¥ 9-2 PAC¤ÎÎ㡤¿´¼¼¤Ïº¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯¤ÎÍͤÀ¤¬¡¤TÇȤÏÉÔÌÀ¡¤¿ÇÃǤε­½Ò¤Ê¤·¡¥ ÁÎ˼PÇÈ 9-5 P-mitrale, LVH, IVCD, RÇȤÎÁý¹â¤Ç¤Ï¤Ê¤¯¸º¿ê¤·¤Æ¤¤¤ë¡¥ 9-6 P-mitrale, biatrial enlargememnt, LVH(aVL>11mm), LAH 9-7 P-mitrale, Long-QT 9-8 WAP¤ÇÉÑÇPÇȤËTÇȤ¬½ÅÀѤ¹¤ë¤ÈÈó¾ï¤Ë¹â¤¤PÇȤˤʤ롥 9-9 RAE¡¤ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ 9-10 PAE, PAD, PJC, IRBBB¤Ç¤¢¤ë¡¥qR'¤ËRVH¤Ï¸ºß¤·¤Ê¤¤¡¥cf ECG 11-15¡¥ IACD V1¤Ç¤Î2ÁêÀ­PÇȤÏÁ´¤ÆIACD(intra atrial conduction delay) 9-11 IACD¤ÎRAE¤ÎÎ㡤LAD, LAH, ¶Ëü¤Ê»þ·×²óž¤ÇV6¤Ç¤âtransition¤¬¸«¤¨¤Ê¤¤¡¥ 9-12 IACD¤ÎLAE¤ÎÎ㡤PJC¤¬¤ß¤¨¤ë¡¥¿´¼¼¶½Ê³¤Ïabberancy¡¥ 9-13 IACD¤ÎLAE¤ÎÎ㡤II, III, aVF¤ËQÇÈ¡¥ÂоÎÀ­TÇÈȿž¡¥ II,III,aVF¤Ï¤ÏÂоÎÀ­È¿Å¾TÇÈ¡¤V1-6¤ÏÁ´¤ÆÈóÂоΥ¹¥È¥ì¥¤¥óTÇÈ¡¤ »Í»è¤Ï¿åÊ¿ST¡¤LVH¡¤º¸Ë¼Éé²Ù¡¤²¼Êɹ¼ºÉ 9-14 LAE¡¤IRBBB¤«ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¤RVH? ±¦¼´Êа̡¤II, III, aVF¤ÎTÇȵÕž¤Ï RVH¤Ëɬ¿Ü¡¥cf 11-12. V1¤Ï¶¯¤¤QRÇÈ·Á¡¤V2¤Ï¾®¤µ¤ÊrS¤ÇÄ̾ï¤ÎV1¤Î¤è¤¦¤Ë¸«¤¨¤ë¡¥V1-V4¤Ï±¢À­ ¥¹¥È¥ì¥¤¥óTÇÈ¡¥¶»Éô¤è¤¦¤¦¤Ç¤ÎÉý¤Î¶¹¤¤SÇȤϱ¦¼¼ÈîÂç¤ËÆÃħ¡¥ 9-15 IACD¤ÎLAE¤ÎÎ㡤LAH¡¤STD 9-16 IACD¤ÎLAE¤ÎÎ㡤I, aVL°Ê³°¤ÎÁ´¤Æ¤ÎͶƳ¤ÇQS¥Ñ¥¿¡¼¥ó¡¥1¡ë¤ÎAV¥Ö¥í¥Ã¥¯¡¥ 9-17 IACD¤ÎLAE¤ÎÎ㡤III, aVF¤ÎQÇȤÏÉý¤¬¶¹¤¯°Û¾ï¤Ç¤Ï¤Ê¤¤¡¥ I¡¤aVL¤ËÂ礭¤Ê¥Î¥Ã¥Á¡¤IVCDefect¤«¡©º¸¼¼¹âÅṲ̋ÈI, V5-V6¤Î¥¹¥È¥ì¥¤¥óT¤Ç º¸Ë¼Éé²Ù¡¤º¸¼¼ÈîÂç¡¥ 9-18 RAE, LAE, »Í»èͶƳ¤ÇTÇȤ¬¤Ê¤¤¡¥ 9-19 RAE, LAE, IVCD¤«RBBB¤Ë¸«¤¨¤ë¡¥ 9-20 RAE, LAE, TaÇȤ¬¸«¤¨¤ë¡¥ 9-21 RAE, LAE
PRÌܼ¡¤ËÌá¤ë¡£
TESTECG 15 10-1 pericarditis. PR²¼¸þ¡¥JÅÀ¾å¾º¡¤ST¤Ï¾å¤Ë±ú¡¤QRS¤Î½ª¤ï¤ê¤Ë¥Î¥Ã¥Á¡¥ ¤³¤ÎECG¤Èbenign early reporalization¤È¤Î¶èÊ̤ÏÆñ¤·¤¤¡¥ 10-2 LGL¾É¸õ·²¡¤¥¸¥§¡¼¥à¥¹(James)«¡¥final p.112. V1¤ÎRÇȤ¬¹â¤¤Íýͳ¤Ï¤ï¤«¤é¤Ê¤¤¡¥AVN¤È¤Î¥ë¡¼¥×¤ò²ð¤·¤ÆAVNRT¤Ë¤Ê¤ë¡¥ ¿´Ë¼¥Ú¡¼¥·¥ó¥°¤ò¹Ô¤¦¤È¸º¿êÅÁƳ¤ò¤»¤º¤Ë¿´¼¼¤Ï»É·ã¤ËÄɽ¾¤¹¤ë¡¥ 10-3 Type A WPW 10-4 Type A WPW 10-5 Type B WPW, PAC, WAP¤¬¤¢¤ë¤¬¡¤¸«¤Ä¤«¤é¤ó¡¥V1¤ÈV2¤ÇȽ¤ë¡¥ ²¾À­QÇȤòAMI¤Ë´Ö°ã¤¨¤Ê¤¤¤è¤¦¤Ë¡¥¤Þ¤¿ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤È¤â´Ö°ã¤¨¤ë¡¥ WWW¾É¸õ·²¤ÏÉÑÇïȯºî¤¬¤¢¤ë´µ¼Ô¤ò¼¨¤·¡¢Ã±¤Ë¦¤ÇȤ¬Â¸ºß¤¹¤ë¾ì¹ç¤Ï WWW¥Ñ¥¿¡¼¥ó¤È¤¤¤¦¡¥ 10-6 Type C WPW, P-R´Ö³Ö¤Ï±äĹ¡¤ 10-7 Type A WPW, III¤ÈaVF¤Ç¸«¤é¤ì¤ë¥Î¥Ã¥Á¤Î¶¯¤¤QRS¤Ï¡¤ isolated intraventricular conduction delay(IVCD)¤ÇBBB¤È¿ÆÀÌ¡¥ 10-8 Type A WPW, Digoxin¤ÇËß¾õTÇȤˤʤäƤ¤¤ë¡¥ 10-9 Type B WPW, ±¦µÓ¥Ö¥í¥Ã¥¯·¿¤Î¿´¼¼ÉÑÇï¡¥±¦Â¦Kent«¤òÄ̲᤹¤ë¤«¤é º¸¼¼¤¬Àè¤Ë¶½Ê³¤¹¤ë¡¥ 10-10 LBBB·¿ÉÑÇï¤Ë¸«¤¨¤ë¤¬¦¤ÇȤ¬Â¸ºß¤¹¤ë¡¥300 BPM°Ê¾å¤ÎÉÑÇï¤ÏAV¥Î¡¼¥É¤Ï ²ðºß¤·¤Ê¤¤¡¥250°Ê¾å¤Ç¤¢¤ì¤ÐAV¥Î¡¼¥É¤Î²ðºß¤ÏÈÝÄê¤Ç¤­¤Ê¤¤¡¥ 10-11 orthodromic tachycardia OARVT 280 BOM, QRSÉý¤Ï¶¹¤¤¡¥PÇȤ¬³Îǧ¤Ç¤­¤Ê¤¤ ¤Î¤ÇPSVT¤È¤Î´ÕÊ̤Ϻ¤Æñ¡¥½ç¹ÔÀ­Ë¼¼¼¥ê¥¨¥ó¥È¥ê¡¼À­ÉÑÇï 10-12 WPW¤Î¿´Ë¼ÁÆÆ°¡¤ÀäÂÐÉÔÀ°Ì®(irregularly irregular)¡¤STD¤¬¸«¤¨¤ë¡¥ 10-13 ´Ö·çŪWPW¡¥ 10-14 ´Ö·çŪWPW¡¤Type B 10-15 1¡ëAV¥Ö¥í¥Ã¥¯¡¤²¼Êɹ¼ºÉ¡¤±¦¼¼¹¼ºÉ¡¥V1¤ÎSTE¤Ï̵»ë¤Ç¤­¤Ê¤¤¡¥ V1¡ÁV5¤Þ¤Ç¤ÎRRÁý¹âÉÔÎɤâ̵»ë¤Ç¤­¤Ê¤¤¡¥ 10-16 1¡ëAV¥Ö¥í¥Ã¥¯¡¤Â¦Êɵõ·ì¡¥ 10-17 0.48sec¤Î1¡ëAV¥Ö¥í¥Ã¥¯¡¤sinus escape, CRBBB, ¸åÊɹ¼ºÉ¡¥ 10-18 Wenckebach 2¡ë¥Ö¥í¥Ã¥¯¡¤sinus escape, CRBBB, ¸åÊɹ¼ºÉ¡¥ 10-19 Wenckebach 2¡ë¥Ö¥í¥Ã¥¯¡¤ 10-20 3¡ëAV¥Ö¥í¥Ã¥¯¡¤¥Ö¥í¥Ã¥¯ÇÈ·Á¤ÇT¤¬¹â¤¤¤È¹âK·ì¾É¡¥ 10-21 3¡ëAV¥Ö¥í¥Ã¥¯¡¤junctional escape, RBBB¤ÈLAH¡¤¥Ú¡¼¥·¥ó¥° 10-22 3¡ëAV¥Ö¥í¥Ã¥¯¡¤ventricular escape, idioventricalr rhythm (¿´¼¼¸ÇͭĴΧ). QRSÉý0.12sec, v1¡ÁV3¤ÏQS¥Ñ¥¿¡¼¥ó¡¤V6¤Ï´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤Ë¸«¤¨¤ë¡¥ ¥¢¥È¥í¥Ô¥ó¡¤¥Ú¡¼¥·¥ó¥°
RAHÌܼ¡¤ËÌá¤ë¡£
ÇÙÀ­¿´¡¤Ãæ³ÖQÇÈ ÇÙÀ­PÇȰʳ°¤Ë¡¤»Í»è¤ÎÃæ³ÖQÇȤ¬¸«¤¨¤ë¡¥²¼Êɹ¼ºÉ¤Ë¤¹¤ë¤È¡¤ST¤ÎÊѲ½¤¬¤Ê¤¤¡¥ Ãæ³ÖQÇȤÏÈîÂçÀ­¿´¶Ú¾É¤Ç¤â¤¢¤ë¡¥¿´¶Ú¾É¤Ç¤Ï¶»ÉôͶƳ¤Ç¤â¸«¤¨¤ë¡¥
BAHÌܼ¡¤ËÌá¤ë¡£

QRSÌܼ¡¤ËÌá¤ë¡£
11-1 low voltage 11-2 low voltage 11-3 LBBB, AMI
LVHÌܼ¡¤ËÌá¤ë¡£
Luna¤è¤ê A¤ÏÀµ¾ï¡¤B¤Ïº¸¼¼¼«Í³ÊɤÎÈî¸ü¡¤C¤Ïº¸¼¼Ãæ³Ö¡¤¿´ÀíÉô¤ÎÈî¸ü¤ò¼¨¤¹¡¥p.138 Luna¤è¤ê º¸¼¼ÈîÂç¤Î¥Ù¥¯¥È¥ë¿´ÅÅ¿Þ p.138 Luna LVH.pdf V1¤Þ¤¿¤ÏV2¤ÎSÇȤÈV5¤Þ¤¿¤ÏV6¤ÎRÇȤÎϤ¬¡æ35mm°Ê¾å¡¥ ¤É¤ì¤«¤Î¶»ÉôͶƳ¤¬¡æ45mm°Ê¾å¡¥ aVL¤ÎRÇȤ¬¡æ11mm°Ê¾å¡¥ I¤ÎRÇȤ¬¡æ12mm°Ê¾å¡¥ aVF¤ÎRÇȤ¬¡æ20mm°Ê¾å¡¥ ¾åµ­¤Î¤É¤ì¤«¤¬³ºÅö¤¹¤ë¤Èº¸¼¼ÈîÂç¤Þ¤¿¤Ïº¸¼¼³ÈÄ¥¤Ç¤¢¤ë¡¥ (PRD(PR´Ö³Ö¤Î²¼¹ß¤¬0.8mm°Ê²¼¤Ê¤éÀµ¾ï¤Ç¤¢¤ë¡¥p.180) 11-4 º¸¼¼ÈîÂç¤Ë¤è¤ëLVH 11-5 º¸¼¼³ÈÄ¥¤Ë¤è¤ëLVH¡¤I, II, III, aVF, V5, V6¤Ç¤Î 1mm°Ê²¼¤Î¾®¤µ¤ÊQÇȤϺ¸¼¼³ÈÄ¥¤ÎÆÃħ¡¥ ¾å¸þ¤­¤Ë±ú¤ÎST¥»¥°¥á¥ó¥È¤ÈTÇȤϥ¹¥È¥ì¥¤¥ó(strain)ÇÈ·Á¤Ç¤¢¤ë¡¥ 11-6 ŵ·¿Åª¤ÊLVH¤Ç¤Ï¤Ê¤¤¡¥UÇÈ 11-7 º¸¼¼¹âÅÅ°Ì¡¤»Í»èͶƳ¤Î¥Õ¥é¥Ã¥È¤ÊTÇÈ¡¥ÈóÆðÛŪSTÊѲ½ 11-8 LVH, ¥¹¥È¥ì¥¤¥ó¥Ñ¥¿¡¼¥óµÕžTÇÈ¡¤ V1, V2¤Ïconcave upward TÇÈ¡¤V3¤Ï¾å¸þ¤­ST¥»¥°¤ÇµÕžTÇÈ¡¥¤è¤¤Îã¤Ç¤¢¤ë¡¥ 11-9 LGL¾É¸õ·²¡¤ÉÑÌ®¡¤LVH¡¤ÇÙÀ­PÇȤǤϤʤ¤¡¥ 11-10 LVH, RAE, LAE, late intrinsicoid deflection, GE #298 I¤ÎRÇȤÎÁ°¤Ë¥®¥¶¥®¥¶¤¬¸«¤¨¤ë¡¥II¤Ë¦¤ÇÈÍͤˤߤ¨¤ë¤¬WPW¤Ç¤Ï¤Ê¤¤¡¥ 11-11 RAE¡¤LAE¡¤LVH¡¤»Í»èͶƳ¤Îflat¤ÊTÇÈ¡¤ÈóÆðÛŪSTÊѲ½¡¥
RVH Ìܼ¡¤ËÌá¤ë¡£
Luna RVH.pdf A¤ÏÀµ¾ï¡¤B¤Ï±¦¼¼ÈîÂç¡¥ ±¦¼¼ÈîÂç¤Ë¤ÏÅŵ¤¼´¤¬Á°±¦¼´Êа̤ȸ屦¼´Êа̤ÎÆó¤È¤¦¤ê¤¬¤¢¤ë¡¥ Á°Êý·¿¤Ï±¦µÓ¥Ö¥í¥Ã¥¯·¿¤ÇR'¤¬Â礭¤¤¡¥ ¸åÊý·¿¤ÏV1¤¬rS¤Ë¤Ê¤ë¡¥Á°Êý¡¤¸åÊý¶¦¤ËV6¤ÎSÇȤ¬Â礭¤¤¡¥ S1S2S3¤Ï¸åÊý·¿¤ÇÉÔÄê¼´¤È¤Ê¤ë¡¥ ºÇ¤âÏÀÍýŪ¤ËÀâÌÀ¤·¤Æ¤¤¤ë¡¥ ¡ù ±¦¼´ÊѰ̤ÇV1¤ÎÂ礭¤ÊRÇȤÏRVH¤ò¹Í¤¨¤ë¡¥V1¤ÏËܼÁŪ¤ËrSr'¤Ç¤¢¤ë¡¥ ¤½¤Î2ÈÖÌܤÎr'¤¬Â礭¤¯¤Ê¤ë¤È±¦µÓ¥Ö¥í¥Ã¥¯¤«¡¤RVH¤Ë¤Ê¤ë¡¥±¦µÓ¥Ö¥í¥Ã¥¯¤Î ¾ì¹ç¤Ï±¦¼¼ÅÁƳ¤¬¶áÀÜ¿´¶Ú¤ÎÅÁƳ¤Ë¤Ê¤ë¤¿¤á¡¤Éý¤¬¹­¤¯¤Þ¤¿¿¶Éý¤âÂ礭¤¤¡¤ °ìÊý¡¤±¦¼¼ÈîÂç¤Ï¥×¥ë¥­¥ó¥¨Àþ°Ý¤ÎÅÁƳ¤Ç¤¢¤ë¤«¤éÅÁƳ»þ´Ö¤¬Ã»¤¯SÇȤΠÉý¤â¶¹¤¯¤Þ¤ë¡¥rSr'¤ÎºÇ½é¤Îr¤ÏÃæ³Ö¿´¶Ú¤Î¶½Ê³¡¤SÇȤϺ¸¼¼¶½Ê³¤Ç¤¢¤ê¡¤ ºÇ¸å¤Îr'¤Ï±¦¼¼¿´¶Ú¤Î¶½Ê³¤Ç¤¢¤ê¡¤Ä̾ï¤Ïr'¤¬¾®¤µ¤¯É½¤À¤Ã¤Æɽ¤ì¤Ê¤¤¡¥ ¥Ö¥ë¥¬¥À¤Î¾ì¹ç¤Ï±¦¼¼Î®½ÐÏ©¤Î¿´¶ÚÈîÂ礬¤¢¤ë¤¿¤á¡¤Â礭¤Êr'¤È¹Í¤¨¤ì¤Ð ǼÆÀ¤¬¤¤¤¯¡¥ ¡ù Ä̾ï¤ÏRBB¤¬Â¸ºß¤¹¤ë¤ÈRVH¤Î¿ÇÃǤϤǤ­¤Ê¤¤¤¬¡¤GE #121¤ÏRVH¤Î¿ÇÃǤ¬²Äǽ¤Ç¤¢¤ë¡¥ ¡ù BB p.73¤Ç¤Ï3¼ïÎà¤ÎRVH¤¬É½¼¨¤µ¤ì¤Æ¤¤¤ë¡¥ ±¦¼¼ÈîÂç¤Î3 type Utah ECG Uwave Right Ventricular Hypertrophy General ECG features include: * Right axis deviation (> 90 degrees) * Tall R-waves in RV leads; deep S-waves in LV leads * Slight increase in QRS duration * ST-T changes directed opposite to QRS direction (i.e., wide QRS/T angle) * May see incomplete RBBB pattern or qR pattern in V1 * Evidence of right atrial enlargement (RAE) (lessonVII) Specific ECG features (assumes normal calibration of 1 mV = 10 mm): * Any one or more of the following (if QRS duration < 0.12 sec): o Right axis deviation (> 90 degrees) in presence of disease capable of causing RVH o R in aVR ¡æ 5 mm, or o R in aVR > Q in aVR * Any one of the following in lead V1: o R/S ratio > 1 and negative T wave o qR pattern o R gt; 6 mm, or S < 2mm, or rSR' with R' > 10 mm * Other chest lead criteria: o R in V1 + S in V5 (or V6) 10 mm o R/S ratio in V5 or V6 < 1 o R in V5 or V6 < 5 mm o S in V5 or V6 > 7 mm * ST segment depression and T wave inversion in right precordial leads is usually seen in severe RVH such as in pulmonary stenosis and pulmonary hypertension. BB¤Î¥¯¥é¥¤¥Æ¥ê¥¢ p.73 * QRS¤ÎÅŵ¤¼´¤¬90¡ë°Ê¾å¤ÏÀäÂоò·ï¤Ç¤¢¤ë¡¥ a. qR ¤ÎV1 b. V1¤ÎR¤¬7mm°Ê¾å¡¥ c. V1¤ÎR/SÈ椬1°Ê¾å¡¥ d. V1¤ÎID¤¬0.03sec°Ê¾å¡¥ e. V1¡ÁV6¤ÎQRS¤¬rSÇÈ·Á¡¥ f. Âç¿Í¤ÇS1S2S3ÇÈ·Á¡¥ * ÇÙÀ­PÇÈ¡¥ * V1¡ÁV2¤ÎSTD¤ÈȿžTÇÈ¡¥ 9-14 LAE¡¤IRBBB¤«ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¤RVH? ±¦¼´Êа̡¤II, III, aVF¤ÎTÇȵÕž¤Ï RVH¤Ëɬ¿Ü¡¥cf 11-12. V1¤Ï¶¯¤¤QRÇÈ·Á¡¤V2¤Ï¾®¤µ¤ÊrS¤ÇÄ̾ï¤ÎV1¤Î¤è¤¦¤Ë¸«¤¨¤ë¡¥V1-V4¤Ï±¢À­ ¥¹¥È¥ì¥¤¥óTÇÈ¡¥¶»Éô¤è¤¦¤¦¤Ç¤ÎÉý¤Î¶¹¤¤SÇȤϱ¦¼¼ÈîÂç¤ËÆÃħ¡¥ 11-12 ŵ·¿Åª¤ÊRVH¡¤strain pattern¡¥S1Q3T3¤¬¸«¤¨¤ë¡¥RVH¤ÎV1¤ËqÇȤϤʤ¤¡¥RAE, LAE 11-13 ÈóÄ귿ŪRVH¡¤V2¤Ç R/S ratio¤¬1°Ê¾å¡¥ Á°ÊÉÃæ³Ö¹¼ºÉ¤òʻȯ¤·¤Æ¤¤¤ë¤¿¤á¹âV1¤Ë¤Ê¤é¤Ê¤¤±¦¼¼ÈîÂç¡¥´ÕÊÌ¿ÇÃÇ¡¥ GE #121 II, aVF¤¬¡Ý¤À¤«¤é¼´¤Ï-30¡ë°Ê²¼¡¤V1¤¬PVC¤Î¤è¤¦¤Ë¸«¤¨¤ë¤¬µðÂç¤ÊrsR' ¤Ç¤¢¤ë¡¥V1-V3¤Þ¤ÇrsR'¤ÇȿžTÇÈ¡¤V4-V6¤ÏrSÇȤÇÍÛÀ­TÇÈ¡¥ ¿ÇÃÇ¡§LAFB+CRBBB¡¥ËÜÍèRBBB¤Ï±¦¼¼ÈîÂç¤Î¿ÇÃǤϽÐÍè¤Ê¤¤¤¬¡¤ V1¤Î°Û¾ï¤Ê¹â¤µ¤ÎR'¤ÈV6¤ÎSÇÈ¡¤¤½¤·¤ÆȿžTÇȤÏRVH¤òµ¿¤ï¤»¤ë¡¥ Ä̾ï¤ÎCRBBB¤Ç¤ÏV6¤ÏRÇȤÈÉý¹­¤ÎSÇȤǤ¢¤ë¤¬¡¤RVH¤Ç¤ÏRÇȤ¬¾®¤µ¤¯¡¤ SÇȤϱԤ¯¿¼¤¤¡¥LAFB¤¬¹çÊ»¤¹¤ë¤ÈV6¤ÎSÇȤϤµ¤é¤Ë¿¼¤¯¤Ê¤ë¡¥ GE #196 ¼´90°Ê¾å¡¤ÇÙÀ­PÇÈ¡¤V1¤ÏrsR'¤Ç¤¢¤ë¤¬¡¤rs¤ÏÈó¾ï¤Ë¾®¤µ¤¤¡¥R'¤Ï¥·¥ã¡¼¥×¤Ç Ä̾ï¤Î±¦µÓ¥Ö¥í¥Ã¥¯¤È°Û¤Ê¤ë¡¥V2¡ÁV6¤Þ¤Ç¤Ï¶¯¤¤Éý¤Î¶¹¤¤SÇÈ¡¥±¦µÓ¥Ö¥í¥Ã¥¯ ¤Ç¤¢¤ì¤ÐS¤ÏÉý¤¬¹­¤¤¤«¤é¡¤¤³¤ÎÅÀ¤«¤é¸«¤Æ¤âRBBB¤È¤Ï°Û¤Ê¤ë¡¥V1¤Ï ±¢À­TÇȤǡ¤V2¤Ïʿó¡¤V3-V6¤ÏÄ̾ï¤ÎTÇÈ¡¥RÇȤÏV3¤¬ºÇ¤â¹â¤¯¡¤ V6¤Ë¹Ô¤¯¤Ë¤·¤¿¤¬¤Ã¤ÆÇȹâ¤Ï¾®¤µ¤¯¤Ê¤ë¡¥ÇÙÀ­PÇȤȱ¦¼¼ÈîÂç¡¥ 11-14 ventricular escape beat¡¤35 BPM¡¤IVCD, TÇȤÏQRS¤¬2ÁêÀ­¤Ç¤¢¤Ã¤Æ¤âµÕž¤¹¤ë¡¥¹âK·ì¾É 8.7 mEq/L¡¥ final¤Ç¤ÏAf¤Ëȼ¤¦ÅÁƳ¤Ç1ͶƳ¤·¤«É½¼¨¤µ¤ì¤Æ¤¤¤Ê¤¤¡¥final p.169 11-15 qR'¤ÎRBBB 11-16 VT, ¹âK·ì¾É 9.4mEq/L 11-17 Àµ¾ïPÇÈ¡¤3¡ëAV¥Ö¥í¥Ã¥¯¡¤CLBBB¡¤CRBBB¡¤Àµ¾ïQRS 2¼ïÎà¤ÎPÇÈ¡¤PAC¤Î¸å¤ËÊѲ½¤·¤Æ¤¤¤ë¡¥ 11-18 VTach (VT)¡¤LAH¡¤ÊаÌÅÀ¤ÏV1¤ÈV2¤Î´Ö¡¥ 11-19 Àµ¾ïqÇȤȰ۾ïQÇÈ¡¤»Í»èͶƳ 11-20 Àµ¾ïqÇȤȰ۾ïQÇÈ¡¤¶»ÉôͶƳ 11-21 IIIͶƳSÇȤθƵ۰ÜÆ°¡¤°Ü¹ÔÂÓ¤ÏV1¡ÁV2¤ÇV1¤Î¿¶Éý¤¬¾®¤µ¤¤¡¥NSSTC¡¤PR¤ÎÄã²¼ ¿ÇÃǤϽñ¤«¤ì¤º¡¥
transitonÌܼ¡¤ËÌá¤ë¡£
11-22 II, III, aVF¤ÎQÇȤ¬¸²Ãø¡¤V4¡ÁV6¤ÎQÇÈ¡¤V1¤ÎRÇȤ¬¹â¤¯Éý¤¬¹­¤¤¡¥ ²¼ÊÉ¡¤Â¦Êɤι¼ºÉ¤ÎϢ³À­¤«¤é¸åÊɤι¼ºÉ¤¬¹Í¤¨¤é¤ì¤ë¡¥transition¤ÏV1¡ÁV2¡¥ I¤ÎqÇȤϾ¯¤·Â礭¤¯°Û¾ï¡¤aVL¤ÎqÇȤâ°Û¾ï¤Ç¹â°Ì¦Êɹ¼ºÉ¡¥ V1¤ÎRÇȤ¬¹â¤¯Éý¤¬¹­¤¤¤Î¤Ï¡¤¸åÊɹ¼ºÉ¤¬¤¢¤Ã¤¿¤³¤È¤ò¼¨¤¹¡¥ V1,V2¤ÎJÅÀ¤¬Äã²¼¤·¤Æ¤¤¤Ê¤¤¤³¤È¤Ï¡¤¸åÊɤÎST¾å¾º¤¬¤Ê¤¤¤³¤È¤ò¼¨¤¹¡¥ ²¼Êɹ¼ºÉ¤Î°Û¾ïQÇȤÏIII>aVF>II¤Î½ç¤Ë¾®¤µ¤¯¤Ê¤ë¤¬¡¤¹â°Ì¦Êɹ¼ºÉ¤¬ ȯÀ¸¤¹¤ë¤ÈI¤Ç°Û¾ïQÇȤ¬¸«¤¨¤ë¤¿¤áIII¤Ç¤Î°ú¤­»»¹â²½¤¬¾Ã¤µ¤ì¤ë¡¥ aVL¤ÎQÇȤθº¿ê¤ÏaVL=(i-III)/2¤À¤«¤éI¤ÎQÇȤ«¤éIII¤ÎQÇȤò°ú¤¯¤¿¤á¤Ë ¤µ¤é¤Ë¾®¤µ¤ÊQÇȤˤʤ롥 11-23 II, III, aVF¤Ï°Û¾ïQÇÈ¡¤V1¤ÎQSÇȤÏÀµ¾ï¡¤V2S+V5R>35mm¤À¤«¤éLVH¡¥ 11-24 II, III, aVF¤Î°Û¾ïQÇȤÈST¾å¾ºÈ¿Å¾TÇÈ¡¤ LAE¡¤V4¡ÁV6¤ÎTÇȵÕž¡¥TR¤ÏV2¡¤¸åÊɹ¼ºÉ¤«RVH¤Ï ²áµî¤Î¿´Åſޤˤè¤ê·è¤Þ¤ë¡¥¤³¤ÎECG¤À¤±¤Ç¤ÏȽÃǤǤ­¤Ê¤¤¡¥ 11-25 »Í»èͶƳÄãÅÅ°Ì¡¤Åŵ¤¼´¿åÊ¿¡¤V1QS¤Ë¶á¤¯ÄãÅÅ°Ì¡¤V2¡ÁV4¤ÎSTȿž¤ÏÀµ¾ï¡¥ TR¤ÏV5¡ÁV6¡¥LAE¡¤¼ã´³PRD¡¤effusion¡© 11-26 QT±äĹ¡¤1¡ëAV¥Ö¥í¥Ã¥¯¡¤»Í»èÄãÅÅ°Ì¡¤TR¤ÏV5¤«¤éV6¡¥V1¤ÏQSÇȤǤϤʤ¯rÇȤ¬¤¢¤ë¡¥ II, V2¡ÁV5¤Þ¤Ç¤Î¸²Ãø¤ÊPRD¤¬¤¢¤ë¤«¤épericarditis¡¥ »Í»èÄãÅṲ̋ˤÏPRD¤ËÃí°Õ¤¹¤ë¤³¤È¡¥ 11-27 I, aVL¤ÎÅŰ̹â¤è¤êLVH¡¤Æ¶À­ÉÔÀ°Ì®¡¤Åŵ¤¼´¤Ï¿åÊ¿¡¤TR¤ÏV1¡ÁV2¡¤È¿»þ·×²óž¡¥ RVH¤Ë¤Ê¤ë¤¬¡¤¼´¤¬±¦¼´Êа̤Ǥʤ¤¡¥Î¾¿´³ÈÄ¥¤È²òÅú¤·¤Æ¤¤¤ë¡¥ ÈîÂç¤ÏST¤¬È¿Å¾¡¤³ÈÄ¥¤ÏST¤¬Àµ¾ï¡¥ 11-28 RAE¡¤TR¤ÏV1¤ÈV2¤Î´Ö¡¤TÇÈȿž¡¥±¦¼¼ÈîÂ礫¸åÊɹ¼ºÉ¤«¡¥ ¸åÊɹ¼ºÉ¤Ê¤éII, III, aVF¤ÎÊѲ½¤¬É¬Íס¥
OsbornÌܼ¡¤ËÌá¤ë¡£
RÇȤνªÎ»»þ¤Î¤³¤Ö¡¥ ÄãÂβ¹¤ÇȯÀ¸¤¹¤ë¡¥¤½¤Î¤¿¤á¤Ë½ùÌ®¤¬Â¿¤¤¡¥p.230 ¡É²¼¸þ¤­¤Ë¤¯¤Ó¤ì¤¿¥Î¥Ã¥Á¤ÏÃÙ¤ì¤ÆȯÀ¸¤·¤¿¿´ÆâË즿´¶Ú¤Î æʬ¶Ë¤È³¤¯¿´³°Ë즿´¶Ú¤Îæʬ¶Ë¤Ç¤¢¤ë¡¥ ξ¼Ô¤Îæʬ¶Ë¤¬´ËËý¤À¤È¥¹¥é¡¼¾õ¤Ë´Ý¤¯¤Ê¤ë¡¥ ST¥»¥°¥á¥ó¥È¤Ï¿åÊ¿¡¤JÅÀ¤ÎÄã²¼¤òȼ¤¦Äã²¼¡¤JÅÀ¤Î¾å¾º¤òȼ¤¦¾å¾º ¤Ê¤É¤¬¤¢¤ë¡É 11-28 Notch¤ÈJ wave¡¤¹â¤¤ÈóÂоΤÎTÇÈ¡¥ 11-31 Osborn 11-32 Osborn 11-33 Osborn 13-1 RBB¤Îŵ·¿Î㡤VͶƳ¤ÇR:S ratio¤Ïɬ¤ºÂ礭¤¯¤Ê¤ë¡¥qR'¤Ç¤¢¤Ã¤Æ¡¤qR¤È¤Ï½ñ¤«¤Ê¤¤¡¥ 13-2 rsr'r''·¿¤ÎRBBB¡¤LAH¤òȼ¤¦2»Þ¥Ö¥í¥Ã¥¯¡¥ 13-3 rsr'r''·¿¤ÎRBBB¡¤inferolateral ischemia¡¥
WATÌܼ¡¤ËÌá¤ë¡£
WAT: wandering atrial pacemeker iregurary iregular ÀäÂÐÉÔÀ°Ì®
MATÌܼ¡¤ËÌá¤ë¡£
MAT: fultifocal atrial tachycardia iregurary iregular ÀäÂÐÉÔÀ°Ì® TESTECG 21 ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤Ç¤¢¤ë¤¬²¼Êɹ¼ºÉ¤Î½ê¸«¤¬¤Ê¤¤¡¥
IVCDÌܼ¡¤ËÌá¤ë¡£
BB 20, 42, 47, 112, 112, 117, 119-121, 125, 127, 129, 131, 133 135-139, 355, 370-372, 175, 376, 432 IVCD¤ÎÆÃħ¡§ 12 lead ¤Ë¤è¤ì¤Ð(p.289) ¡¤IVCD¤Ï¶É½êŪIVCD¡¤¤¹¤Ê¤ï¤Á1ͶƳ¡¤ ÆäËIII¤Ç¸«¤é¤ì¤ëQRSÉý 0.12sec°Ê²¼¤Î¥Î¥Ã¥Á¤Î¤¢¤ëÇÈ·Á(localized IVCD)¤È¡¤ Á´Í¶Æ³¤Ç¤ß¤é¤ì¤ë0.12sec°Ê¾å¤ÎQRS¤ò¤â¤ÄÇÈ·Á¤Ç¤¢¤ê¡¤ ÆäËLBBB¤äRBBB¤ÎÆÃħ¤ò¤â¤¿¤Ê¤¤ÇÈ·Á(Generarized IVCD)¤Ë¶èÊ̤µ¤ì¤ë¡¥ °ìÈÌIVCD¤ÏV1¤Çº¸µÓ¥Ö¥í¥Ã¥¯·¿¡¤V6¤Ç±¦µÓ¥Ö¥í¥Ã¥¯·¿¤ò¼¨¤¹¡¥ V1¤ÏrS¤Çº¸µÓ¥Ö¥í¥Ã¥¯ÍͤǤ¢¤ë¤¬¡¤¤½¤Î¸åRS¥Ñ¥¿¡¼¥ó¤ÇV6¤Ç¤âRÇȤÎÁý¹âÉÔÎɤΠ¤Þ¤Þ¤Ç¤¢¤ê¡¤ÊѲ½¤Ë˳¤·¤¤¡¥QRSÉý¤Ï3mm¤Ç´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤È¶èÊ̤¬Æñ¤·¤¤¡¥ ¤·¤«¤·¡¤´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤À¤È±¦¼¼¤¬Àè¤Ë¶½Ê³¤¹¤ë¤¿¤áV6¤ÎSÇȤϤʤ¤¡¥ IVCD¤¬¤¢¤ë¾ì¹çQTc >0.5sec¡¨¤Ê¤±¤ì¤Ð > 0.44sec (ÃË)¡¤> 0.46sec (½÷) IVCD¤Î¥·¥ß¥å¥ì¡¼¥·¥ç¥ó
IIͶƳ¤ä¡¤V6¤Î¥·¥ß¥å¥ì¡¼¥·¥ç¥ó¤ò¼¨¤¹¡¥ 2018ǯ 10·î 29Æü ·îÍËÆü 23:27:15 JST 8mEq/L°Ê¾å¤Î¹âK·ì¾É¤ÇIVCD¤Ë¤Ê¤ë¡¤¿´ÆâËì¦PerkinjeÅÁƳ®ÅÙ¤¬¶Ëü¤Ë Äã²¼¤·¡¤¼þ°Ï¤Î°ìÈÌ¿´¶Ú¤ÎÅÁƳ®ÅÙÄã²¼¤Ï¾¯¤Ê¤¤¡¤¤½¤Î·ë²Ì¡¤rÇȤθå¤Ë ¿´³°Ë즤¬Àè¤Ë¶½Ê³¤·¡¤Â礭¤ÊSÇȤ¬À¸¤¸¤ë¡¥¤½¤Î¸å¡¤¿´ÆâË즤ζ½Ê³¤Ë¤è¤ê SÇȤξå¸þÉôʬ¤¬À¸¤¸¤ë¡¥SÇȤβ¼¹ßÀþ¤Ï¾å¸þÀþ¤ËÈæ¤Ù¤ÆÈæ³ÓŪµÞ½Ô¤Ç¤¢¤ë¡¥ ¤³¤ì¤Ï¿´³°Ë즿´¶Ú¤ÎÅÁƳ®ÅÙ¤¬Áᤤ¤³¤È¤ò¼¨¤·¤Æ¤¤¤ë¡¥ GE #239 IVCD¤Ç¤¢¤ë¡¥ GE #305 PQû½Ì¡¤ ¿ÇÃÇ¡§WPW¡¥V4-6¤ÎSÇȤÏÀµ¾ï¤Ç¤¢¤ê¡¤IVCD¤ÏÈÝÄê¤Ç¤­¤ë¡¥ GE #32¤ÏI¤Ç¤ÎRÇȤÎΩ¾å¤ê¤¬ÃÙ¤¯¡¤V1¤Ç¤Ï²¼¹ß¤¬»Ï¤Þ¤Ã¤Æ¤«¤érÇȤΥΥåÁ¤¬¸«¤¨¤ë¡¥ º¸µÓ¤Î²¼¹ß¶½Ê³¤¬ÃÙ¤ì¤Æ¤«¤é±¦µÓ¤Ë¶½Ê³¤¬ÅÁ¤ï¤ë¡¥IVCD¤È¤¤¤¦¤è¤êILBBB¤È¿ÇÃǤ¹¤Ù¤­¡¥ GE #243¤ÏQRSÉý¤¬0.16ÉäÎIVCD¡¥V1-2¤ÎSÇȤÎΩ¾å¤ê¤Ç¥Î¥Ã¥Á¤¬¸«¤¨¤ë¡¥ V1¤ÎrÇȤÏÀµ¾ï¡¤STE¤À¤«¤é¡¤µÞÀ­Á°Êɹ¼ºÉ¤Ç¤¢¤ë¡¥LAFB¤Ç¤¢¤ë¡¥ ¼´¤Ï-60¤À¤«¤éLAFB¡¤LAFB¤ÏRÇȤÎÁý¹âÉÔÎɤÈV6¤Ç¤ÎSÇȤòȼ¤¦¡¥ aVL¤ÎqÇȤÏseptal q¤ò¼¨¤¹¤«¤éº¸µÓ¥Ö¥í¥Ã¥¯¤Ç¤Ï¤Ê¤¤¡¥ ²¼¿Þ¤ÏGE #243 GE #248¤ÏQRSÉý¤¬0.10¤ÎIVCD¡¤»þ·×²óž¤Ç¤¢¤ë¤¬¡¤SÇȤÎΩ¾å¤ê¤Ç¥Î¥Ã¥Á¤¬¤¢¤ë¡¥ GE #305¤Ï°ì¸«IVCD¤Ë¸«¤¨¤ë¤¬WPW¤Ç¤¢¤ë¡¥ intraventricular conduction defect p.94 ecg 9-5 Ä̾ï¤ÎQRS¤Î´Ö¤Ë¥®¥¶¥®¥¶¤¬È¯À¸¤·¡¤¥¹¥à¡¼¥º¤Ê¶½Ê³ÅÁƳ¤¬¤Ç¤­¤Ê¤¤¾õÂÖ¡¥ ecg 9-5¤ÏIVCDdelay¤Ç¤â¤¢¤ë¡¥V1¤Ïº¸µÓ¥Ö¥í¥Ã¥¯·¿¡¤V6¤Ï¿¶Éý¤¬¾®¤µ¤¯¤Æ¤âRS·¿¤Ç¤¢¤ë¡¥ ¤Þ¤¿V1¤Þ¤¿¤ÏV2¤ÎSÇȤ¬ºÇ¤âÂ礭¤¯RÇȤÎÁý¹âÉÔÎɤΤޤÞV6¤ËÅþ¤ë¤Î¤â¶¦Ä̤·¤Æ¤¤¤ë¡¥ intraventricular conduction delay (IVCD) 12 LEAD ECG p.289 QRSÉý¤¬0.12sec°Ê¾å¡¤V1¤ÏLBBBÍͤÇV6¤ÏRBBBÍͤÎÇÈ·Á¤ÈÄêµÁ¤µ¤ì¤ë¡¥ ¹âK·ì¾É¤ÎËö´üŪÇÈ·Á¡¥ 141f ecg 10-7, WPW Type A¤ÎÎã¤Ç¤¢¤ë¤¬¡¤III¤ÈaVF¤ÏPÇȤ¬¸«¤¨¤º¡¤ Ê£»¨¤ÊQRSÇÈ·Á¤Ç¤¢¤ë¡¥¤³¤ì¤ÏIVCD¤È¿ÇÃǤ¹¤ë¡¥(Æüì¤ÊÎã) p.336 ecg 14-8¤Ï¥Æ¥ó¥È¾õTÇÈ¡¤IVCD¤ÏV5, V6¤ÇRSÇÈ·Á¤Ë¤Ê¤é¤Ê¤¤¤¬¡¤IVCD¤È¿ÇÃÇ¡¥ 198f ecg 11-14, ¹âK·ì¾É¤Ë¤è¤ëIVCD¡¤QRS¤ÎÉý¤¬¹­¤¯¡¤½ùÌ®¡¤¿´¼¼¸ÇͭĴΧ¡¤ V1¤Ïº¸µÓ¥Ö¥í¥Ã¥¯¤Î·Á¤Ç¤¢¤ë¤¬¡¤V4¤Þ¤ÇÊѲ½¤¬¾¯¤Ê¤¤¡¥V6¤ÏRSÇÈ·Á¤Î¤Þ¤Þ¤Ç¤¢¤ë¡¥ QRSÉý¤Ï6mm (ŵ·¿Åª¤ÊÎã) 12 lead ECG pp. 289-293 13-21 PR 0.2sec, 77 bpm, IVCD 13-22 PÇȤʤ·¡¤48 bpm, QRS 0.24sec IVCD¡¤QT´Ö³Ö¤Ï±äŤ»¤ºÀŻ߾õÂÖ¤¬¤¢¤ë¡¥ p.336 14-18¤Ï¥Æ¥ó¥È¾õTÇÈ¡¤IVCD¤ÏV5, V6¤ÇRSÇÈ·Á¤Ë¤Ê¤é¤º¡¤ÇÈ·Á¤¬»÷¤Æ¤¤¤ë¡¥ 13-23 ¿´¼¼¥Ú¡¼¥·¥ó¥°¤Ë¤è¤ë¿´¼¼ÇÈ·Á¡¤IVCDÍͥѥ¿¡¼¥ó 14-57 IVCD, QRS 0.18, ´ðËÜŪ¤ËI¤ÈV6¤Ï»÷¤¿ÇÈ·Á¤Ç¤¢¤ë¤¬¡¤V6¤ÏRS¥Ñ¥¿¡¼¥ó¡¥QRS¤¬0.12sec°Ê²¼¤À¤ÈLAFB¤Ë¤Ê¤ë¡¥TÇȤˤĤ¤¤Æ¤ÏºÇ¸å¤ÎSÇȤò´ð½à¤Ë¹Í¤¨¤ë¤ÈƱÁê(concordant)¤Ë¤Ê¤ë¤¬¥Ö¥í¥Ã¥¯¤À¤«¤é°Û¾ï¤Ç¤¢¤ë¡¥
STÊѲ½Ìܼ¡¤ËÌá¤ë¡£
STC.pdf
LAEÌܼ¡¤ËÌá¤ë¡£
º¸Ë¼³ÈÂ硤left atrial enlargement, ±¦Ë¼¤Î¶½Ê³¤Î¸å¡¤º¸Ë¼¶½Ê³¤¬¸²Ãø¤Ë¤ß¤¨¤ë¤«¤éÆóÁÐÀ­¤ÎPÇȤˤʤ롥 Ãæ±û¤¬³ç¤ì¤ÆÉý¤Ï0.12Éðʾ塤ξĺÅÀ¤Î´Ö³Ö¤Ï0.04Éðʾ塥 PÇȤ볤òhump¤È¸À¤¤¡¤two humps, a double hump ¤Èɽ¸½¤¹¤ë¡¥(hump¤È¤ÏÇ­ÇؤΰÕÌ£) 0.12Éðʲ¼¤Ç¥Î¥Ã¥Á¤Î¤¢¤ëPÇȤÏLAE¤È¤Ï¿ÇÃǤ·¤Ë¤¯¤¤¡¥ 12 Lead ECG¤Îp. 93. ECG 9-5 V1¤ÎSÇȤ¬35mm°Ê¾å¡¤V6¤ÎRÇȤ¬¾®¤µ¤¤¡¤LVH¤È¿ÇÃǤǤ­¤ë¡¥ ECG 9-6 AVL¤ÎRÇȤ¬11mm °Ê¾å¡¤LAH, LVH ECG 9-7 LAE¤Èlong QT, V4-6¤ÎST¥»¥°¥á¥ó¥È¤ÏŤ¯¡¤Ëß¾õ¤Ç¤¢¤ë¡¥2Áê¤Î±äĹ¤Ï³Î¤«¡¤ ¤·¤«¤·¡¤TÇȤβ¼¹ßÀþ¤¬µÞ½Ô¤È¤Ï¸À¤¨¤Ê¤¤¡¥
LAHÌܼ¡¤ËÌá¤ë¡£
LAH Left Anterior Hemiblock º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯ II < 0 ¤Ê¤é axix < -30¡ë II,III,aVF¤Î¤É¤ì¤«¤Ë¾®¤µ¤ÊrÇȤ¬É¬Íס¥ ¤Þ¤¿¡¤I¤ÏqR¤â¤·¤¯¤ÏRÇÈ¡¤III¤ÏrSÇȤ¬É¬Íס¥ II,III,aVF¤ËrÇȤ¬Ìµ¤¯¤¹¤Ù¤ÆQÇȤʤ鲼Êɹ¼ºÉ¤Ç¤¢¤ë¡¥ ¶»ÉôͶƳ¤Ï¤¹¤Ù¤Æ¥¹¥é¡¼¤Ç¤Ê¤¤SÇȤ¬½Ð¸½¤¹¤ë¡¥ ¤³¤ì¤Ï±¦¼¼¤Ç¤Ï¤Ê¤¯¡¤º¸¼¼Â¦Êɤζ½Ê³ÃÙ±ä¤ò°ÕÌ£¤¹¤ë¡¥ 13-24 LAH, Axis <-30¡ë¡¤I¤ËqR¡¤III¤ËrS¤¬¸«¤¨¤ë¡¥TR¤ÏV4¤À¤¬V6¤ÇRS¥Ñ¥¿¡¼¥ó 13-25 LAH, Axis <-30¡ë¡¤I¤ËqR¡¤III¤ËrS¤¬¸«¤¨¤ë¡¥TR¤ÏV5¤À¤¬V1¤«¤éV6¤ÇRS¥Ñ¥¿¡¼¥ó 13-26 LAH, Axis <-30¡ë¡¤III¤ËrS¤¬¸«¤¨¤ë¡¥»Í»èͶƳÄãÅÅ°Ì¡¤¸ÆµÛÀ­°ÜÆ° 13-27 LPH¡¤RAE, LAE, II,III,aVF¤ÎST²¼ÊýµÕžTÇÈ¡¥S1Q3T3¤ÎÇÙ¹¼ºÉ¤È¤Î´ÕÊÌ¤Ï ÍúÎò¤¬É¬Íס¥¤á¤º¤é¤·¤¤¡¥ 13-28 Tachycardia¡¤LPH¡¤¹âK·ì¾É¡¥QT¤Ï±äŤ·¤Æ¤¤¤ë¤¬»Í»èͶƳ¤Ç¤Î¿åÊ¿ST¤¬¤Ê¤¤¡¥ 13-29 ¶¯¤¤»þ·×²óž¤Ç¤¢¤ë¤¬¡¤Â¦Êɹ¼ºÉ¤Î¾Úµò¤¬¤Ê¤¤¡¥S1Q3T3¤Ç¤¢¤ë¤¬ ÉÑÌ®¡¤±¦Ë¼Éé²Ù¡¤V1¤Ê¤É¤Ç±¦¿´Éé²Ù¤Î ħ¸õ¤¬¤Ê¤¤¡¥·ë²Ì¤È¤·¤ÆLPH¤Ë¤Ê¤ë¡¥ 13-30 S1Q3T3, RAE, qR'¤Ç¤Ï¤Ê¤¯qR¤Ç±¦¼¼ÈîÂç¡¥¶¯Îõ¤ÊÈ¿»þ·×²óž¡¥RVH¤Ç¤¢¤ë¡¥ È¿»þ·×²óž¤ÏV1¤ÇRS·¿¤Ë¤Ê¤ë¤«¤é±¦¼¼ÈîÂç¤Î¾ò·ï¤Ë¤Ê¤ë¡¥ÇÙÀ­PÇÈ¡¤S1Q3T3¤Ï ÇÙ¹¼ºÉ¤Îħ¸õ¡¥Axis¤¬90¡ë°Ê¾å¤ÏLPH¤ÎÁ°¤Ë±¦¼¼ÈîÂç¤ò¹Í¤¨¤ë¡¥ LPH¤Ï¤Þ¤ì¤Ç¤¢¤ë¡¥ V1¤ÎqÇȤÏËÜÍèrÇȤξì½ê¤Ç¤¢¤ë¤¬¡¤±¦¼¼Â¦¤ÎÃæ³Ö¤¬¸ü²á¤®¤Æº¸Êý¤Ë ¶½Ê³ÅÁƳ¤·¤¿¤È¹Í¤¨¤ë¡¥¤Þ¤¿V1R¤ÎĺÅÀ¤ÈV3R¤ÎĺÅÀ¤Î»þÁ꤬°ìÃפ¹¤ë ¤³¤È¤«¤é±¦¼¼Á°Êɶ½Ê³¤¬º¸¼¼¶½Ê³¤Ë¾¡¤Ã¤¿¤È¹Í¤¨¤ë¡¥ 13-31 III¤ÎqÇȤÈST¾å¾º¤ËÃíÌܤ¹¤ë¡¥LPH¤Ç¤Ï¤Ê¤¯¡¤IWMI¤Ç¤¢¤ë¡¥ 13-32 RBBB¤ÈLAH¡¤NSR¡¤1¡ë¥Ö¥í¥Ã¥¯¡¤LVH 13-33 RBBB¤ÈLAH¡¤NSR¡¤1¡ë¥Ö¥í¥Ã¥¯¡¤LVH 13-34 RBBB¤ÈLAH¡¤PÇȤϤʤ¯¡¤ÀäÂÐÉÔÀ°Ì®¡¥ 13-35 RBBB¤ÈLAH¡¤NSR¡¤LVH 13-36 RBBB¤ÈLAH¡¤NSR¡¤LVH
LPHÌܼ¡¤ËÌá¤ë¡£
LPH Left Posterior Hemiblock º¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯ 13-37 RBBB¤ÈLPH¡¤NSR¡¤RAE¡¤LAE¡¤¶»ÉôÅŶËÉÔÎÉ¡¥ 13-38 RBBB¤ÈLPH¡¤I¤¬rS¤ÇIII¤¬qR(qS)¤À¤«¤éÅŵ¤¼´¤Ï90¡ë°Ê¾å¡¥ 13-39 RBBB¤ÈLPH¡¤I¤¬rS¤ÇIII¤¬qR(qS)¤À¤«¤éÅŵ¤¼´¤Ï90¡ë°Ê¾å¡¥ 504f-509f, 522f ecg 16-21 »°´Ä¹³±µÌô¤Ë¤è¤ëIVCD¡¤1¡ëAV¥Ö¥í¥Ã¥¯¡¥ V1¤ÏrS¤Çº¸µÓ¥Ö¥í¥Ã¥¯ÍͤǤ¢¤ë¤¬¡¤¤½¤Î¸åRS¥Ñ¥¿¡¼¥ó¤ÇV6¤Ç¤âRÇȤÎÁý¹âÉÔÎɤΠ¤Þ¤Þ¤Ç¤¢¤ê¡¤ÊѲ½¤Ë˳¤·¤¤¡¥QRSÉý¤Ï3mm¤Ç´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤È¶èÊ̤¬Æñ¤·¤¤¡¥ ¤·¤«¤·¡¤´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤À¤È±¦¼¼¤¬Àè¤Ë¶½Ê³¤¹¤ë¤¿¤áV6¤ÎSÇȤϤʤ¤¡¥ 621, 626, 627, 657
QTcÌܼ¡¤ËÌá¤ë¡£
13 B QTc¬Äê¤È¤½¤Î°ÕÌ£


¡¡QT»þ´Ö¤È¤Ï¿´ÅÅ¿Þ¤ÎqÇȤλϤޤ꤫¤éTÇȤνªÎ»»þ¤Þ¤Ç¤Î»þ´Ö¤Ç¤¢¤ê¡¤¿´¼¼¶Ú¤Î¼ý½Ì»þ´Ö(APD)¤òɽ¤¹¡¥¿´¶Ú¼ý½ÌÎϤ¬¶¯¤±¤ì¤Ð¿´¼¼¤Ë½¼Ëþ¤·¤¿·ì±Õ¤Ïû»þ´Ö¤Ç¶î½Ð¤Ç¤­¡¤QT»þ´Ö¤Ïû¤¯¤Ê¤ë¡¥µÕ¤Ë¼ý½ÌÎϤ¬¼å¤¯¤Ê¤ë¤È¶î½Ð»þ´Ö¤¬Ä¹¤¯¤Ê¤êQT»þ´Ö¤Ï±äŤ¹¤ë¡¥¤Þ¤¿¿´Çï¿ô¤Ë¤â±Æ¶Á¤ò¼õ¤±¡¤¸ò´¶¿À·Ð»É·ã¤Ç¿´Çï¿ô¤¬Â¿¤¯¤Ê¤ë¤È¡¤¿´¶Ú¼ý½ÌÎϤâÁý²Ã¤¹¤ë¤¿¤á¤Ë QT»þ´Ö¤Ïû¤¯¤Ê¤ë¡¥ QT»þ´Ö¤Ï¿Þ35-A¤Ë¼¨¤¹ÊýË¡¤Ç¬Äꤵ¤ì¤ë¡¥UÇȤˤĤ¤¤Æ¤ÏÌ®Ç郎ÃÙ¤¤¤È¤­¤Ë¤è¤¯½Ð¸½¤¹¤ë¤¬¡¤Ä㥫¥ê¥¦¥à·ì¾É¤Ç¤Ïɬ¿Ü¤Î½ê¸«¤Ç¤¢¤ë¡¥ TÇȤÎÇȹâ¤Î1/2¤è¤êÂ礭¤¤¾ì¹ç¤Ï UÇȤνªÎ»»þ¤Þ¤Ç¤ò´Þ¤á¤ë¤¬¡¤¤½¤ì°Ê²¼¤ª¤è¤ÓÆÈΩ¤·¤¿UÇȤξì¹ç¤ÏTÇȤνªÎ»»þ¤Ç·×¬¤¹¤ë¡¥¤·¤¿¤¬¤Ã¤ÆÆÈΩ¤·¤¿UÇȤÏQT»þ´Ö¤Ë´Þ¤á¤Ê¤¤¤³¤È¤Ë¤Ê¤ë¡¥

¡¡Àµ¾ï¿´ÅÅ¿Þ°ÂÀÅ»þ¤Ç¤ÎQT»þ´Ö¤È¿´Çï¿ô¤È¤Î´Ø·¸¤ò·×¬¤¹¤ë¤È¿Þ35-B¤Î¤è¤¦¤Ë¿´Çï¿ô¤ËÂФ·¤ÆľÀþŪ¤Ë¸º¾¯¤¹¤ë¡¤¤½¤³¤Ç¿´Çï¿ô¤Î±Æ¶Á¤ò½ÐÍè¤ë¤À¤±¾¯¤Ê¤¯¤¹¤ë¥¤¥ó¥Ç¥Ã¥¯¥¹¤òµá¤á¤ëÊýË¡¤È¤·¤ÆBazett¤ÏRR´Ö³Ö¤ò¤â¤Á¤¤¤Æ°Ê²¼¤Ë¼¨¤¹ÊäÀµ¼°¤ò¹Í°Æ¤·¡¤QTc¤È¤è¤Ö¤³¤È¤Ë¤·¤¿¡¥

QT (msec), RR (sec)


¤³¤³¤ÇQT¤Ïmsec¡¤RR´Ö³Ö¤ÏÉäȤ¹¤ë¡¥¤³¤Î¼°¤«¤éʬ¤«¤ë¤è¤¦¤Ë¿´Çï¿ô¤¬ 60°Ê²¼¤Ç¤¢¤ë¤ÈʬÊ줬1°Ê¾å¤Ë¤Ê¤ê¡¤QTc¤Ï¾®¤µ¤ÊÃͤˤʤꡤ¿´Çï¿ô¤¬Â礭¤¯¤Ê¤ë¤ÈÂ礭¤ÊÃͤËÊäÀµ¤µ¤ì¤ë¡¥¤³¤ÎÊäÀµ¤Ë¤è¤ëQTc¤ÈǯÎð¤Î´Ø·¸¤ò¿Þ35-C¤Ë¼¨¤¹¡¥·¹¸þ¤È¤·¤Æ¤Ï¡¤QTc¤Ë10ºÍ¤Þ¤Ç¤ÏÃ˽÷¤Îº¹¤Ï¤Ê¤¤¡¥¤·¤«¤·10ºÍ¤ò±Û¤¨¤ë¤È½÷À­¤ÏÊѲ½¤¬¾¯¤Ê¤¤¤¬¡¤ÃËÀ­¤ÎQTc¤ÏµÞ·ã¤Ë²¼¹ß¤·¡¤25ºÍÄøÅ٤ǺǾ®¤Ë¤Ê¤ë¡¥¤½¤Î¸å¡¤Î¾¼Ô¤ÏǯÎð¤È¶¦¤Ë´Ë½ù¤ËÁý²Ã¤·¡¤80ºÍ¤ò±Û¤¨¤ë¤ÈµÞ·ã¤ËÁý²Ã¤¹¤ë¡¥ Ê¿¶Ñ¤È¤·¤ÆÀ®¿ÍÃËÀ­¤Ï400 msec¡¤½÷À­¤Ï414 msec¤Ç¡¤ÃˤÎÊý¤¬¿´¶Ú¼ý½ÌÎϤ¬Á᤯¡¢20ºÍ¤¬ºÇ¤âÎ϶¯¤¯¡¤Î¾¼Ô¶¦¤Ë80ºÍ¤ò²á¤®¤ë¤ÈµÞ·ã¤Ë¿ê¤¨¤ë¤³¤È¤ò¼¨¤·¤Æ¤¤¤ë¡¥ÆüËܽ۴Ĵï³Ø²ñ¿ÇÃÇ´ð½à¤Ë¤è¤ë¤È¡¤QTc¤¬ 480msec°Ê¾å¤¬3ÅÀ¡¤460¡Á479 msec¤¬2ÅÀ¡¤450¡Á459 msec¤¬1ÅÀ¤Î²ÃÅÀ¤òÉÕ¤±¤Æ¤¤¤ë¡¥¿Þ35-D¤ËQT-¿´ÇïºÂɸ¤Ë¤ª¤±¤ëQTc¤Î´Ø·¸¤ò¼¨¤·¡¤É½35-E¤ËQT±äĹ¾É¸õ·²¤Î¿ÇÃÇ´ð½à¤ò¼¨¤¹¡¥Í×Ì󤹤ë¤ÈQTc¤È¤Ï¿´¼ý½ÌÎϤÎɾ²Á»Øɸ¤Ç¤¢¤ë¤È¶¦¤Ë¡¤QRSÉý¤ÎÊѲ½¤¬¾¯¤Ê¤¤¤³¤È¤è¤êTÇȤÎÉý¤Î±äŤ¬ºÇ¤âÂ礭¤Ê°ø»Ò¤È¤Ê¤ë¡¤¶Ëü¤Ê¹â¥«¥ê¥¦¥à·ì¾É¤ÇȯÀ¸¤¹¤ëIVCD¤Ç¤ÏQTc¤Ï¶ËÅ٤˱䍷¡¤R on T¤Ë³¤¯VT¤Îȯ¸½¤ÏÅöÁ³¤Î»ö¤È¤·¤Æ¹Í¤¨¤é¤ì¤ë¡¥


¿Þ35-A QT»þ´Ö¤Î¬ÄêË¡
QT»þ´Ö¤Î¬Äê¤ÏqÇȤλϤޤ꤫¤éTÇȤνªÎ»»þÅÀ¤òÌܻؤǷèÄꤹ¤ë¤è¤ê¡¤TÇȤβ¼¹ßÉô¤ÎÀÜÀþ¤òÁª¤Ö¤Î¤¬°ÂÁ´¤Ç¤¢¤ë(A)¡¥UÇȤÏÀµ¾ï¿´Åſ޽ФâÌ®Ç郎ÃÙ¤¯¤Ê¤ë¤ÈȯÀ¸¤¹¤ë¤¬¡¤Ä㥫¥ê¥¦¥à·ì¾É¤Ç¤Ïɬ¤ºTÇȤ˳¤¤¤Æ½Ð¸½¤¹¤ë¡¥¤³¤Î¾ì¹ç¡¤B¤Ë¼¨¤¹¤è¤¦¤ËTÇȤÎÇȹâ¤Î1/2°Ê²¼¤Ç¤¢¤ì¤ÐÍ­¤Ï¤ò̵»ë(B)¡¤1/2°Ê¾å¤Ç¤¢¤ì¤ÐUÇȤβ¼¹ßÉô¤ÎÀÜÀþ¤Ç½ªÅÀ¤òÄê¤á¤ë(C)¡¥


¿Þ35-B °ÂÀÅ»þ¿´ÅÅ¿Þ¤ÈQT»þ´Ö¤È¿´Çï¿ô¤Î´Ø·¸
Êƹñ4ɱ¡¤Ç¤Î(½÷À­4883¿Í¡¤ÃËÀ­5420¿Í)¤Î¼«Æ°·×¬¤ÇÀµ¾ï¤È¿ÇÃǤµ¤ì¤¿¥Ç¡¼¥¿¡¥Ä¾Àþ²óµ¢¤Çy=-19+527¤¬ÆÀ¤é¤ì¤¿¡¥Çò´Ý¤¬ºÇ¤âÉÑÅÙ¤¬¹â¤¯²óµ¢Ä¾Àþ¤Ë½¸Ã椷¤Æ¤¤¤ë¡¥
(ʸ¸¥¡§LuoS, et. al. A comparion of commonly used QT correction formula : The effect of heart rate on the QTc of normal ECGs. J Electorcaridol. 2004:37(Suppl):81-90)


¿Þ35-C Bazett¼°¤ÇÊäÀµ¤·¤¿QTc¤ÎÃ˽÷ÊÌǯÎð¿ä°Ü
ÀÖ¥Þ¡¼¥¯¤ÏÃËÀ­¡¤¹õ¥Þ¡¼¥¯¤Ï½÷À­¡¥
(ʸ¸¥¡§½©»³½Óͺ QT´Ö³Ö¤Ë¤è¤ë¿´µ¡Ç½É½²½¤Èͽ¸å¤Îͽ¬¡¥
ÆüËÜ¿´Åſ޳زñ»ï 2013, 33:223-246 ¤è¤ê°ìÉô²þÊÑ)


¿Þ35-D QT-¿´ÇïºÂɸ¤Ë¤ª¤±¤ëQTc¤Î´Ø·¸
Ê¿¶ÑQt¿´ÇïľÀþ¤òNormal line¤È¤·¤ÆQTc¤Î±äĹÃͤòÇËÀþ¤Ç¼¨¤¹¡¥¼ÂÀþ¤ÏQTc¤¬480 msec¤Ç¿ÇÃÇ´ð½à¤Ë¤è¤ë¤È¥°¥ì¡Ý¥É3¤Ë¤¢¤¿¤ë¡¥Normal line¤Î²¼Êý¤Ë¼¨¤¹¶ÊÀþ¤ÏSQT¤Î¿ÇÃÇ´ð½à¤ËÁêÅö¤¹¤ë¡¥


ɽ35-E QT±äĹ¾É¸õ·²¤Î¿ÇÃÇ´ð½à
QT±äĹ¾É¸õ·²¤ÈBrugada¾É¸õ·²¤Î¿ÇÎŤ˴ؤ¹¤ë¥¬¥¤¥É¥é¥¤¥ó(2012)¤è¤ê¡¥

QTc¤Ë¤è¤ë¿´µ¡Ç½É½²½¤Èͽ¸å¤Îͽ¬" QTc¤Î¼°¡§ Bazett: QTcB=QT/(RR)1/2 Friderica:QTcF=QT/(RR)1/3 Hodges: QTcH=QT+105(1/RR-1) Bazett¡¤Friderica¡¤Hodges¤ÎÊäÀµ¼°¤Ç¤ÏRR¤Îñ°Ì¤Ïsec¤ò»ÈÍѤ¹¤ë¡¥ Framingham: QTcFr=QT+0.154(1000-RR) RR¤Îñ°Ì¤Ïmsec¤ò»ÈÍѤ¹¤ë¡¥
Ê¿¶Ñ¡§À®¿ÍÃËÀ­ 400msec, ½÷À­ 414msec
ÃˤÎÊý¤¬¿´¶Ú¼ý½ÌÎϤ¬Á᤯¡¢20ºÍ¤¬ºÇ¤âÎϤĤ褤¡¥

¿ÇÃÇ QTc 480ms °Ê¾å 3 460ms °Ê¾å 2 450ms °Ê¾å 1 ÆüËܽ۴Ĵï³Ø²ñ¿ÇÃÇ´ð½à gnuplot set grid set xrange [40:160] plot 480*sqrt(60)/sqrt(x) with lines lw 2 dt 1 replot 460*sqrt(60)/sqrt(x) with lines lw 2 dt 2 replot 450*sqrt(60)/sqrt(x) with lines lw 2 dt 3 replot -1.9*x+527 with lines lw 2 replot 360*sqrt(60)/sqrt(x) with lines lw 2 dt 4 replot 340*sqrt(60)/sqrt(x) with lines lw 2 dt 5 replot 330*sqrt(60)/sqrt(x) with lines lw 2 dt 6

long_QTÌܼ¡¤ËÌá¤ë¡£
lqt.gif QT»þ´Ö¤¬R-R´Ö³Ö¤Î1/2°Ê¾å¤Ç¤¢¤ì¤Ðlong QT, ¤¹¤Ê¤ï¤ÁQT±äĹ¾É¸õ·²¤È¤¤¤¦¡¥ Ä㥫¥ê¥¦¥à·ì¾É¤ÎUÇȤÏTÇȤβ¼¹ßÉôʬ¤ÈÍ»¹ç¤·¤Æ¤¤¤ë¤¿¤á¤ËUÇȤÏQT»þ´Ö¤Ë ´Þ¤àÊý¤¬¤è¤¤¡¥ ¤·¤«¤·½ùÌ®¤ÇȯÀ¸¤¹¤ëUÇȤÏQT»þ´Ö¤Ë´Þ¤á¤Ê¤¤¤Î¤¬ÂÅÅö¤Ç¤¢¤ë¡¥ 1.5 mEq/L¤ÎÄãK·ì¾É UÇȤξå¤ËPÇȤ¬¾è¤Ã¤Æ¤¤¤ë¡¥ Romano-Word syndrome QT±äĹ¾É¸õ·²¤Ç²¿Å٤⼺¿Àȯºî¤òµ¯¤³¤·¤Æ¤ë¡¥±¢À­TÇȤËÍÛÀ­UÇȤ¬¸«¤¨¤ë¡¥ ÄãCa·ì¾É ST¥»¥°¥á¥ó¥È¤Ï¥Õ¥é¥Ã¥È¤Ç±äŤ¹¤ë¡¤TÇȤÎÇÈ·Á¤ÏÀµ¾ï¡¤ QT±äĹ¾É¸õ·²¤Ç²¿Å٤⼺¿Àȯºî¤òµ¯¤³¤·¤Æ¤ë¡¥±¢À­TÇȤËÍÛÀ­UÇȤ¬¸«¤¨¤ë¡¥ R on T¤«¤éTorsades de Pointes TÇȤξå¤Ç¿´¼¼´ü³°¼ý½Ì¤Ë»÷¤¿ÉûÅÁƳ¤¬È¯À¸¡¤2ÃÊÌ®¤Ç¤¢¤ë¡¤¤½¤Î¸å¡¤¥È¥ë¥µ¥Ç¥Ý¥¢¥óȯÀ¸¡¥ ºÇ¶á¤ÎQT±äĹ¾É¸õ·²¡¤°äÅÁ»ÒÁíÀâ QT±äĹ¾É¸õ·²¤Î¿´ÅÅ¿ÞÊѲ½
Short_QTÌܼ¡¤ËÌá¤ë¡£
Short QT Syndrome Short QT Syndrome.pdf
STÌܼ¡¤ËÌá¤ë¡£
14-1 JÇÈÉÕ¤­¤Î¾å¸þ¤­TÇȤÏscooped¤È¤¤¤¦¡¥Benign Early Repolarisation (BER) 14-2 JÇÈÉÕ¤­¤Î¾å¸þ¤­TÇȤÏscooped¤È¤¤¤¦¡¥PRD¤¬¸«¤é¤ì¤ë¡¥pericarditis. cf 10-1 ȿžTÇÈ¡¥ 14-3 »Í»èʿóTÇÈ(NSSTC)¡¤¶»Éô¤ÏÂоηÁ¤Î±¢À­TÇÈ¡¤µõ·ìÊѲ½¡¥ 14-4 »Í»èȿžTÇÈ¡¤aVF¤ÏÀµ¾ï¡¤¶»Éô¤Ï¤¹¤Ù¤Æȿž¤·¡¤¿¼¤¤TÇÈ¡¥wandering P, µõ·ìÊѲ½¡¥ GE #93 ¶¯¤¤»þ·×²óž¡¤¶»ÉôͶƳ¤Ï¿¼¤¤È¿Å¾TÇÈ¡¤Non-Q MI. 14-5 II,III,aVF¤Î°Û¾ïQÇÈ¡¤III¤Ï¾åTÇÈ¡¤V1¡ÁV6¤Î¿¼¤¤È¿Å¾TÇÈ¡¥LAE. ischemia, CNS, electrolyte, pericarditis, IWMI. Î×¾²È½ÃÇ¡¥ 14-6 TR¤¬V1¡ÁV2, RVH¤Îµ¿¤¤¤¬¤¢¤ë¤¬¡¤¤½¤Î¾ì¹çÈóÂоÎTÇȤǤ¢¤ë¡¥ÂоÎÀ­TÇÈ¤Ç ¥¹¥È¥ì¥¤¥ó¤Ç¤Ï¤Ê¤¤¤Î¤ÇÈÝÄê¤Ç¤­¤ë¡¥ ¥Æ¥ó¥È¾õTÇÈ 14-7 V2,V3¤Ï¥Æ¥ó¥È¾õTÇȤˤߤ¨¤ë¤¬¡¤»Í»è¤ò´Þ¤à¾¤Ç¤ÏTÇȤϾ®¤µ¤¤¡¥ Q-T±äŤÏÄãCa·ì¾É¡¤»Í»è¤ÎÄãÅṲ̋϶»¿å¡¥RAE¤ÈLAE¡¤V5¤ÈV6¤ÎSTÄã²¼¤ÈµÕžTÇÈ¡¥ cf 14-18¤ò»²¾È¤¹¤ë¤È¡¤V6µÕžTÇȤϻϤá¤Ë±ú¡¤¼¡¤ËÆ̤Î2ÁêÀ­¤Ç¤¢¤ë¡¥ 14-8 V2¡ÁV5¤Þ¤Ç¤Ï¥Æ¥ó¥È¾õTÇȤǤ¢¤ë¤¬¡¤¤½¤Î¾¤Ï¾®¤µ¤¤¡¥IVCD, ¹âK·ì¾É¡¥ V6¤ÇRBBBÍÍRSÇȤˤʤäƤ¤¤Ê¤¤¤¬IVCD¤Ç¤¢¤ë¡¥ 14-9 AV sissociation¡¤wide-complex tachycarda. final¤Ç¤ÏQRSÉý¤¬0.12Éðʾå¤Ç¿´Çï100 bpm°Ê¾å¤ÈÄêµÁ¤·¤Æ¤¤¤ë¡¥ ¤µ¤é¤ËÀŻ߾õÂÖ¤¬¤Ê¤¤¾õÂÖ¤³¤È¤¬É¬Íס¥V2¤Ç¤ÏPÇȤ¬¸«¤é¤ì¤ë¤¬Ë¼¼¼²òÎ¥¤¬ ȯÀ¸¤·¤Æ¤¤¤ë¤«¤éVT¤ÈȽÃǤǤ­¤ë¡¥ 14-10 ¹â¤¯¡¤Éý¹­¤¯¡¤´Ý¤¤TÇÈ¡¥CNS¤Þ¤¿¤Ï¹âK·ì¾É¡¥TR¤ÏV2¡ÁV3¡¥2ÁêÀ­¤ÎTÇÈ¡¥ 14-11 3rd AV block LBBBÍͤÎventricular escape¡¤IVCD¤Ç¤Ï¤Ê¤¤. 14-12 hyperacute AMI¡¥²¼Êɱ¦¼¼¹¼ºÉ¡¥I, aVL¤ÎSTÄã²¼¤Ï¥ß¥é¡¼¥¤¥á¡¼¥¸¡¤V1¡ÁV4 ¤ÎST¾å¾º¤Ï¸åÊɹ¼ºÉ¤Î¥ß¥é¡¼¥¤¥á¡¼¥¸¡¥ 14-13 ʿóTÇÈ¡¤LAH¡¤V1¤À¤±¤¬ÈóÂоÎTÇȤǡ¤»Ä¤ê¤ÏÂоÎTÇÈ¡¤°ÊÁ°¤ÎECG¤ò»²¾È¡¥ 14-14 AV dissociation, Junctional escape beat. V2¤ÎST¾å¾º¡¥ CNS¼À´µ¤ÇÉý¹­¤¤È¿Å¾TÇÈ 14-15 ÂоηÁ¤Ç¿¼¤¤µÕžTÇȤÏCNS¼À´µ¤Îŵ·¿¡¥ 14-16 PVC, »Í»èÄãÅÅ°Ì¡¤II, III, aVF¤ÎÉý¹­¤¤È¿Å¾TÇÈ¡¤TR¤ÏV4¡ÁV5¡¤V4¡ÁV6¤ÎSTD¡¤ PÇȤÏ̵¤¯¡¤Junctional escape, LVH¤ÈȽÃÇ¡¥ CNS¼À´µ¤Ç¤¢¤ë¡¥V1¡ÁV3¤ÇTÇȤβ¼¹ßÉô¤Ë±£¤ì¤¿PÇȤ¬¸«¤¨¤ë¡¥ 14-17 »Í»èÉý¹­TÇÈ¡¤V1¤ÏST¾å¾º¡¤V2,V3¤ÏÊèÀÐÍÍ¡¤V4¡ÁV6¤ÏST¾å¾ºÈ¿Å¾TÇÈ¡¥ Á°ÊÉÃæ³Ö¹¼ºÉ¤ÎĶµÞÀ­´ü¡¥ 14-18 »Í»èʿóST¥»¥°¥á¥ó¥È¡¤¶»Éô2ÁêÀ­TÇȤǡ¤Ê¿Ã³ST¥»¥°¡¥QT±äĹ¡¤ ÄãCa·ì¾É¡¥14-7¤Ï¹âK·ì¾É¡¤ÄãCa·ì¾É¤Ç¤¢¤ë¡¥TÇȤϾ®¤µ¤¯¡¤ST¥»¥°¤Ïʿó¡¤ QT±äŤ¬ÆÃħ¡¥V6¤âƱÍͤË2ÁêÀ­TÇȤˤʤäƤ¤¤ë¡¥ µõ·ì½ý³² 14-19 ¥Õ¥é¥Ã¥È¤ÊSTÄã²¼¤ÎTÇÈ¡¥TÇȤ½¤Î¤â¤Î¤Ï¾å¸þ¤­¡¥ severe inferolateral ischemia. 14-20 II, III, aVF¤ÎSTE¡¤I,aVL¤Î¥ß¥é¡¼¡¤V1¡ÁV5¤ÎSTD¡¥²¼Êɱ¦¼¼¹¼ºÉ¡¥ ¸åÊɹ¼ºÉ¤È¤¹¤ë¤ÈV6¤Î¹¼ºÉÊѲ½¤¬¤Ê¤¤¡¥¤·¤¿¤¬¤Ã¤Æ¹¼ºÉ¤Ï±¦¼¼¤«¡© V4¡ÁV6¤Ï¥¹¥È¥ì¥¤¥ó¤ÇLVH¤ÈÆɤá¤ë¡¥ 14-21 II, III, aVF¤Î°Û¾ïQÇȤÈST¾å¾º¡¤V1¡ÁV4¤ÎÊèÀÐÍÍÇÈ·Á¡¤V1¤ÎQSÇÈ¡¤ V5¡ÁV6¤ÎQÇȤÈSTE¡¥ ²¼Êɹ¼ºÉ¡¤Á°ÊÉÃæ³Ö¤Ï¹¼ºÉ¤«¿´¼¼á¤ÏÎ×¾²È½ÃÇ¡¥°ìÈ̤ËV6¤Þ¤Ç¤Î ¿´¼¼áî¤Ï¤Ê¤¤¡¥ 14-22 ¿åÊ¿¤ÊST¤Ïµõ·ìÈ¿±þ¡¤V1¡ÁV4¤Þ¤Ç¤ÎÊèÀÐÍÍTÇÈȿž¡¥ II, III, aVF¤ÎTÇȤÏÈóÂоΤÇÀµ¾ï¤Ç¤¢¤ë¤«¤é¡¤¤½¤ÎqÇȤÏÀµ¾ï¤È¹Í¤¨¤ë¡¥ Á°Êɹ¼ºÉ¤«¿´¼¼á¡© ¥¹¥È¥ì¥¤¥ó¡¤Strain Pattern JÅÀ¤Ï²¼¹ß¡¤²¼¸þ¤­±ú¤ÎST¥»¥°¥á¥ó¥È¡¤È¿Å¾ÈóÂоÎTÇȤ¬ÆÃħ¡¥ 14-23 ÇÙÀ­PÇÈ¡¤±¦¼´Êа̡¤II, III, aVF¤Î¥¹¥È¥ì¥¤¥óTÇÈ¡¤V1, V2¤Î¹âRÇÈ¤È ¥¹¥È¥ì¥¤¥ó¡¤V6¤ÎRSÇÈ¡¤±¦¼¼ÈîÂç¡¥ 14-24 RBBB¡¤¶»ÉôͶƳ¤Ï14-23¤È»÷¤Æ¤¤¤ë¤¬QRSÉý¤Ï0.12Éðʾå¤Ç¤¢¤ê¡¤V6¤ÎSÇÈ¤Ï ¥¹¥é¡¼¡¥ 14-24 ±¦¼´Êа̡¤Î¾¿´Ë¼ÈîÂ硤1SQ3T3¡¤º¸¼¼¹âÅṲ̋è¤êº¸¼¼ÈîÂ硤ξ¿´¼¼ÈîÂç¡¥ º¸¼¼ÈîÂ礬¤¢¤ë¤ÈV1, V2¤ÎRÇȤϱ£¤ì¤ë¡¥ 14-53 pericarditis, early repolarization, PRD¤¬0.8mm°Ê²¼¡¥ 14-54 pericarditis, early repolarization, PRD¤¬0.8mm°Ê¾å¤ÏÍ­°Ù¡¥ 14-55 early repolarization (early ropol) 14-57 IVCD 14-58 CRBBB+LAH 14-59 CLBBB+¦Êɵõ·ì¡¤LBB¤Ç¤Î²¼ÊÉSTD¤ÏÀµ¾ïÈ¿±þ¡¥ 15-13 CRBB¤ÈLAH¤ËȯÀ¸¤·¤¿µÞÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ I,aVL¤ÎSTE¡¤II,III,aVF¤ÎSTD¡¤V1-3¤ÎSTE¡¤V4¤Ç¤Ï¿åÊ¿ST¥»¥°¤¬¤ß¤¨¤ë¡¥ V5-6¤ÏÂ礭¤ÊSÇȤθå¤Ë¾å¸þ¤­TÇȤ¬¤ß¤¨¤ë¡¥ I,aVL¤ÎSTE¤è¤ê¹â°Ì¦ÊÉAMI¤ò¿ÇÃÇ¡¥ Ä̾ï¤ÎCRBBB¤Ï13-14, 13-15¤Ç¸«¤é¤ì¤ë¡¥ 15-25 ²¼Êɱ¦¼¼¹¼ºÉ¡¥ 15-26 ²¼Êɱ¦¼¼¹¼ºÉ¡¥ 15-27 ²¼Êɱ¦¼¼¹¼ºÉ¡¥V4¤ÈV5¤ÎSTÉôʬ¤Î¿¶Æ°¤ÏÉÔÌÀ¡¥ 15-28 Posterior Wall AMI 15-29 ¸Å¤¤IWMI¤ÈPWMI¤ÈLWMI¡¤¿´¼¼¿´ÇPosterior Wall AMI 15-30 µÞÀ­IWMI¤ÈPWMI¤ÈLWMI 15-31 µÞÀ­IWMI¤ÈPWMI¤ÈLWMI 15-32 LBBB¤ËµÞÀ­IWMI¤ÈPWMI¤ÈLWMI 15-33 µÞÀ­IWMI¤ÈPWMI¤ÈRVMI 15-34 µÞÀ­IWMI¤ÈPWMI¤ÈRVMI¡¤V1¤ÎSTD¤Ï¤Ê¤¯¡¤V4-V6¤Þ¤Ç¤ÎSTD¡¤V6R¤ÎSTE¡¤ II¤è¤êIIIͶƳ¤ÎSTE¤¬±¦¼¼¹¼ºÉ¤ÎÆÃħ¤Ç¤¢¤ë¡¥ 15-35 µÞÀ­IWMI¤ÈPWMI¤ÈRVMI¡¤V5-V6¤ÎSTE¤¬¾¯¤Ê¤¤¤¿¤á±¦´§Æ°Ì®Ëܴɤι¼ºÉ¤È ¹Í¤¨¤ë¡¥ 16-6 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-7 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-8 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-9 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-10 ¹âK·ì¾É¤Ë¤è¤ëIVCD¡¤PÇȤÏwandering atrial pacemakter. 16-11 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-12 ¹âK·ì¾É¤Ë¤è¤ëIVCD 16-13A ¹âK·ì¾É¤Î¥Æ¥ó¥È¾õTÇÈ

¿´Ë¼¿ÇÃÇÌܼ¡¤ËÌá¤ë¡£
µÞÀ­¿´³°Ëì±ê¤ÏPR¥»¥°¥á¥ó¥È¤¬Äã²¼¤·¡¤ST¾å¾º¤È´Ö°ã¤¨¤ë¡¥ ¤è¤¯¸«¤ë¤È¡¤¤¹¤Ù¤Æ¤Î»Í»èͶƳ¤ÎST¾å¾º¤Ç¤¢¤ë¡¥Íýͳ¤Ï¡¤ ¿´Ç¹¤Ë¿å¤¬Ãù¤Þ¤ê¡¤¿´³°Ë즺Ù˦³°ÅṲ̋ÎÅÅ°ÌÄã²¼¤Ë¤è¤ë¡¥ ¶»ÉôͶƳ¤ÏR, L, FÅṲ̋¬¥ß¥Ã¥¯¥¹¤µ¤ì¤ë¤¿¤á¡¤ST¾å¾º¤Î¿ÇÃǤËÆñ¤¬¤¢¤ë¡¥ Ê̤ιͤ¨Êý¤ÏPRD (PR depression) ¤Ç¤¢¤ë¡¥¤·¤«¤·´ðÀþ¤«¤é¸«¤Æ¤âST¾å¾º¤ò¤·¤Æ¤¤¤ë¡¥ PRD¤ÎÍý¶þ¤¬¤ï¤«¤é¤Ê¤¤¡¥ÄãÅṲ̋Ͽ´ÅÅ¿Þ¿®¹æ¤ÎϳÅŤˤè¤ë¡¥VͶƳ¤Ç¤âÄãÅÅ°Ì¡¥ prd.png #191 IMG_20170912_0005.pdf final p.142¤è¤ê¡§ ÀܹçÉôĴΧ¡§II¤ÇPÇȲ¼¸þ¤­¡¤QRS¤ÎÁ°¤Ç¤Ï0.12ÉðÊÆ⡤¸å¤Ç¤Ï0.19ÉðÊÆâ¡¥ Àµ¾ïPÇÈ PÇȤÎÅŵ¤¼´¤Ï0¡Á75¡ë¡¤Junctional P¤Ï-60¡Á-80¡ë¡¥p.91 P-mitrale(LAE): p.93 I¤Þ¤¿¤ÏII¤ÇÉý¤¬0.12s°Ê¾å¡¤hump¤ÎĺÅÀ´Ö¤¬0.04s°Ê¾å¡¥ ĺÅÀ´Ö¤¬0.04s°Ê²¼¤Ê¤éLAE¤È¤Ï¿ÇÃǤǤ­¤Ê¤¤¡¥ P-pulmonale(RAE): p.99 ¹â¤µ¤¬2.5mm°Ê¾å¡¥¤½¤ì°Ê²¼¤Ê¤éRAE¤Ç¤Ï¤Ê¤¤¡¥ V1ͶƳ¤ÎPÇȾ®¤µ¤¯¡¤¥Õ¥é¥Ã¥È¤Ë¤Ê¤ë¤³¤È¤¬¤¢¤ë¡¥ Åŵ¤¼´¤¬±¦ÊýÊаܤǡ¤RAE¤Ê¤é¡¤LPH¤Ï¸ºß¤·¤Ê¤¤¡¥ ¿´Ë¼ÆâÅÁƳÃÙ±ä(IACD)¡§p.105 V1¤Ç2ÁêÀ­¤ÎPÇȤǤ¢¤ë¤¬¡¤»Í»èͶƳ¤ÇÇÙÀ­PÇȤäÁÎ˼À­PÇȤˤʤé¤Ê¤¤¾õÂÖ¡¥ ex1 V1¤ÎÁ°È¾¤Î¹â¤µ¤¬V6¤Î¹â¤µ¤è¤êÂ礭¤¤¾ì¹ç -> RAE¤Î²ÄǽÀ­¤¬¹â¤¤¡¥ ex2 V1¤Î¸åȾ¤Î´Ù±ú¤¬1mm¤è¤êÉý¤¬¹­¤¤¾ì¹ç -> LAE¤Î²ÄǽÀ­¤¬¹â¤¤¡¥ ξ¿´Ë¼³ÈÂç(BAE)¡§p.117 ex1 IIͶƳ¤ÎÇÙÀ­PÇÈ¡ÜV1¤Î2ÁêÌܤδٱú ex2 IIͶƳ¤ÎÁÎ˼PÇÈ¡ÜV1¤Î1ÁêÌܤγÈÂç final p.79
ÀܹçÉôĴΧÌܼ¡¤ËÌá¤ë¡£
˼¼¼ÀܹçÉôĴΧ¡¥A-V junctional rhythm. Àµ¼°¤Ë¤Ï¿´Çï¿ô40¡Á60ÄøÅ٤ǡ¤QRS¤ÎÉý¤Ï120m sec°Ê²¼¤ÇÀµ¾ïÇÈ·Á¡¥ ƶ˼ĴΧ¤¬·ç»¤¹¤ë¤¿¤á¤Ë˼¼¼·ëÀá¤ÎÆó¼¡Ä´Î§¤È¤Ê¤ë¡¥ µÕ¹ÔÀ­¤Ë¿´Ë¼ÇÈ·Á¤¬QRS¤Î¸å¤Ç¸«¤¨¤ë¤³¤È¤¬¤¢¤ë¡¥ ¾å¿Þ¤Ï¿´Çï¿ô¤¬73¤Ç¤¢¤ë¤«¤é¡¤Â¥¿ÊÀ­ÀܹçÉôĴΧ¤È¤è¤Ö¡¥
˼¼¼²òÎ¥Ìܼ¡¤ËÌá¤ë¡£

¹âV1RÌܼ¡¤ËÌá¤ë¡£
V1¤ÇRÇȤδÕÊÌ¿ÇÃÇ¡¥ Right ventricular hypertrophy Right bundle branch block Young children and adolesents WPW type A Posterior wall AMI ecg 11-22, GE #57 ecg 11-12, ŵ·¿Åª±¦¼¼ÈîÂç ecg 11-13, Á°ÊÉÃæ³Ö¹¼ºÉ¤òʻȯ¤·¤Æ¤¤¤ë¤¿¤á¹âV1¤Ë¤Ê¤é¤Ê¤¤±¦¼¼ÈîÂç¡¥´ÕÊÌ¿ÇÃÇ¡¥ GE #28¤ÏII,III,aVF¤Î°Û¾ïQÇÈ¡¤V5-6¤Î°Û¾ïQÇȤˤè¤ê²¼ÊɦÊɹ¼ºÉ¡¤V1-2¤ÎRSÇÈ¤Ï ¸åÊɹ¼ºÉ¤Î¤¿¤á¤Ë¹â¤¤RÇȤˤʤ롥 GE #35¤ÏAf¡¤V1¤ÎQR¡¤V2¤ÎrSR'¤½¤·¤ÆV6¤ÎsÇȤˤè¤êIRBBB¡¥ GE #57¤Ï¦ÊɸåÊɹ¼ºÉ¡¥V1-3¤ÏÂоÎÀ­¹âTÇÈ¡¥
±¦µÓ¥Ö¥í¥Ã¥¯Ìܼ¡¤ËÌá¤ë¡£
ge312.png GE #312: ËÜÍ豦µÓ¥Ö¥í¥Ã¥¯¤Ç¤¢¤Ã¤¿ECG¤ËÁ°ÊɦÊɹ¼ºÉ¤¬È¯À¸¡¥ ¤½¤Î·ë²Ì¡¤V1¤ÎrsR'¤Ç¤¢¤Ã¤¿ÇÈ·Á¤¬qR¤Ë¤Ê¤Ã¤¿¡¥V2-6¤Î¶Ëü¤ÊSTE¡¤ ÊèÀÐÍÍÇÈ·Á¤Ë¤Ê¤Ã¤Æ¤¤¤ë¡¥ I¡¤aVL¤âSTE¤¬¤ß¤é¤ì¡¤II, III, aVF¤âSTE¤ÈTÇȹâ¾å¾º¤¬¸«¤é¤ì¤ë¡¥ ¤³¤ì¤ÏµÞÀ­¹¼ºÉ¤Î½é´ü¾É¾õ¤Ç¤¢¤ë¡¥ 12 Lead ECG p.253 ge #304 ¹¼ºÉ¸å¤Î±¦µÓ¥Ö¥í¥Ã¥¯¡¤µÕ¹ÔÀ­PÇȤ¬TÇȤΤ¢¤È¤Ë¤¢¤ë¡¥ TÇȤβ¼¹ßÉô¤¬±äĹ¡¤QTc¤¬¹­¤¯¡¤K¤â¤·¤¯¤ÏMg¤ÎÅŲò¼Á°Û¾ï¡¥ÉÔÀ°Ì®¤ËÃí°Õ¡¥ His¤«¤é¤Ï¤¸¤á¤Ë±¦µÓ¤¬Ê¬»Þ¡¤¤½¤Î¸åº¸µÓ¤«¤éÁ°»Þ¤È¸å»Þ¤¬Ê¬Î¥¤¹¤ë¡¥ º¸µÓ¸å»Þ¤Ï¹­¤¯»Þ¤ï¤«¤ì¤ò¤¹¤ë¤¿¤áº¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯¤Ïµ©¤Ç¤¢¤ë¡¥ ¿´ÅÅ¿Þ¤ÏV1¤ÇRSR'¡¤¤Þ¤¿¤ÏQR'¤Ë¤Ê¤ë¡¥V6¤Ç¤ÏSÇȤ¬³Îǧ¤Ç¤­¤ë¡¥ R'ÇȤβ¼¸þ¤Ï¥¹¥é¡¼¡¤¤Þ¤¿SÇȤϱ¦¼¼¤ÎºÙ˦´ÖÅÁƳ¤Ç²¼¸þ¤â¾å¸þ¤â¥¹¥é¡¼¤Ë¤Ê¤ë¡¥ ¡ú ±¦µÓ¥Ö¥í¥Ã¥¯¤Ç±¦¼¼ÈîÂç¤Ï¿ÇÃǤǤ­¤Ê¤¤¤¬¡¤º¸¼¼¤Ë´Ø¤·¤Æ¤Ï¿ÇÃǤǤ­¤ë¡¥ IRBBB¤ÈLAH¤Ï¿ÇÃDzÄǽ¡¥ecg 10-21 ¤Þ¤¿¡¤±¦µÓ¥Ö¥í¥Ã¥¯¤ÈÁ°ÊÉÃæ³Ö¹¼ºÉ¤â¿ÇÃǤǤ­¤ë¡¥GE #100 ¡ú ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¤ÏV1¤ÇrSR'¤Ë¤Ê¤é¤Ê¤¯¡¤rS¤Ç¡¤V2¤ÇrSR'¤Ë¤Ê¤ë¤â¤Î¤â¤¢¤ë¡¥ V6¤ÎS¤¬Â礭¤±¤ì¤Ð¤½¤Î¤è¤¦¤Ë¿ÇÃǤ¹¤ë¤¬¡¤V6¤ÎS¤¬¾®¤µ¤±¤ì¤ÐIVCD¤Î¿ÇÃǤ¬²Äǽ¤«¤â¤·¤ì¤Ê¤¤¡¥ ¤Þ¤¿¡¤ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¡¤±¦¼¼ÈîÂ硤IVCD¡¤¥Ö¥ë¥¬¥À¾É¸õ·²¤Ï¿ÆÀ̤ɤ¦¤·¤Ç¤¢¤ë¡¥ 13-1 13-2 13-3 Luna: Clinical Electrocardiography p.162 ±¦µÓ¥Ö¥í¥Ã¥¯¤ÎΩÂÎ¥Ù¥¯¥È¥ë¿Þ¡¥ 20180729102729.png rSR'·¿¤Î±¦µÓ¥Ö¥í¥Ã¥¯¤¬Ãæ³ÖÁ°Êɹ¼ºÉ¤ÇqR·¿¤Ë¤Ê¤ë¥á¥«¥Ë¥º¥à¡¥ IMG_20190922_0001.png
º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯Ìܼ¡¤ËÌá¤ë¡£
QRS < 0.12sec, Axis <-30¡ë(º¸¼´ÊÐ°Ì 205), final p.89 (º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯ 511) Ãí°Õ¡§ º¸µÓÁ°»Þ¥Ö¥í¥Ã¥¯¤ÏIIͶƳ¤¬¡Ý¡¤¤·¤¿¤¬¤Ã¤Æ¡¤²¼Êɹ¼ºÉ¤ÎQÇȤȶèÊ̤¹¤ë ɬÍפ¬¤¢¤ë¡¥É¬¤ºrÇȤθºß¤ò³Î¤«¤á¤ë¤³¤È¡¥BB p. 115. LAFB¤Ç»þ¤ª¤êqÇȤ¬V2, V3¤Ç¸«¤é¤ì¤ë¤³¤È¤¬¤¢¤ë¤¬¡¤¤½¤ÎÉý¤Ï¶¹¤¯¡¤Á°Êɹ¼ºÉ¤Ç¤Ï¤Ê¤¤¡¥ °ìÈ̤ËLAFB¤Î¶»ÉôͶƳ¤ÏSÇȤ¬Â礭¤¯¤Ê¤ë¤¬¡¤ÆÃ¤Ë GE #73¤ÏLAFB¤È¶¦¤ËV1-V6¤Þ¤ÇrSÇÈ·Á¤Ç¤¢¤ë¡¤ ¶»ÉôͶƳ¤ÏPRP¤ÇV6¤ËSÇȤ¬È¯À¸¤¹¤ë¡¥¸å»Þ¥Ö¥í¥Ã¥¯¤È¶èÊ̤Ǥ­¤Ê¤¤¡¥ »Í»èͶƳ¤ÎÅŵ¤¼´¤Î¤ß¤Ç¿ÇÃǤ¹¤ë¡¥ Luna: Clinical Electrocardiography p.184 20180729103222.png
º¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯Ìܼ¡¤ËÌá¤ë¡£
QRS < 0.12sec, Axis >90¡ë(±¦¼´ÊаÌ), final p.90 Èó¾ï¤ËÄÁ¤·¤¤¡¥GE #100¤Ï1¡ë˼¼¼¥Ö¥í¥Ã¥¯¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¡¤º¸µÓ¸å»Þ¥Ö¥í¥Ã¥¯¡¥ ¶»ÉôͶƳ¤ÏPRP¤ÇV6¤ËSÇȤ¬È¯À¸¤¹¤ë¡¥Á°»Þ¥Ö¥í¥Ã¥¯¤È¶èÊ̤Ǥ­¤Ê¤¤¡¥ »Í»èͶƳ¤ÎÅŵ¤¼´¤Î¤ß¤Ç¿ÇÃǤ¹¤ë¡¥ Luna: Clinical Electrocardiography p.189 20180729103422.png
º¸µÓ¥Ö¥í¥Ã¥¯Ìܼ¡¤ËÌá¤ë¡£
BB p.128 º¸µÓ¥Ö¥í¥Ã¥¯¤ÎÆÃħ¤ÏV1¤ÇrS¡¤¤Þ¤¿¤ÏQSÇÈ·Á¤Ç¡¤¤³¤ÎÇÈ·Á¤ÏV4ÄøÅ٤ޤdz¤¯¡£ V6¤Ç¤ÏqÇȤΤʤ¤RÇȤÀ¤±¤ÎÇÈ·Á¤Ç¡¤RR'·¿¤Î¥Î¥Ã¥Á¤¬À¸¤¸¤ë¤³¤È¤â¤¢¤ë¡¥ ¤Þ¤¿V6¤Ç¤ÏÅÁƳÃÙ±ä¤Î¤¿¤á¤ËVAT¤Ï0.05Éðʾå¤Ë¤Ê¤ê¡¤ ¥Ç¥ë¥¿ÇÈÍͤΥ¹¥é¡¼ÇÈ·Á¤ò¼¨¤¹¤³¤È¤â¤¢¤ë¡¥¤³¤ì¤Ï±¦¼¼ Ãæ³Ö¿´¶Ú¤«¤éºÙ˦´Ö¶½Ê³ÅÁƳ¤Ë¤è¤ê¡¤º¸¼¼Ãæ³Ö¿´¶Ú¤ò¶½Ê³¤µ¤»¤ë¤¿¤á¤Ç¤¢¤ë¡¥ VAT¤ÏŤ¯¡¤ID¤ÏÀµ¾ï¤À¤«¤éRÇȤΥԡ¼¥¯¤Ï¸å¤Ë¤º¤ì¤ë¡¥ Ãæ³Ö¿´¶Ú¤Î±¦Êý¤Ø¤Î¶½Ê³¤¬¤Ê¤¤¤¿¤áI¤ª¤è¤ÓaVL¤Ç¤ÏqÇȤ¬¸«¤é¤ì¤Ê¤¤¡¥ º¸µÓ¥Ö¥í¥Ã¥¯¤Ë¤Ï´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤ÈÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤¬¤¢¤ê¡¤ QRS < 0.12sec¤Ç¤¢¤ì¤ÐÉÔ´°Á´¡¤¤½¤ì°Ê¾å¤ÎÉý¤Ç¤¢¤ì¤Ð´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤Ç¤¢¤ë¡¥ ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤Ç¤ÏTÇȤÏRÇȤËÂФ·¤ÆµÕž(discordant)¤·¤Æ¤¤¤ë¤¬¡¤ ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤Ç¤¢¤ì¤Ð°ìÃ×(concordant)¤¹¤ë¤³¤È¤¬Â¿¤¤¡¥ ¤³¤ì¤Ï¿´³°Ë즳èÆ°ÅṲ̋ÎÃٱ䤬¾¯¤Ê¤±¤ì¤Ð°ìÃפ·¡¤Â礭¤¤¤Èȿž¤¹¤ë¡¥ ¤Þ¤¿°ì¸«¥Ç¥ë¥¿ÇȤΤ褦¤ÊRÇȤξ徺¤¬¸«¤é¤ì¤ë¤³¤È¤â¤¢¤ë¡¥ QRSÉý¤¬¹­¤¤¤Û¤É¿´µ¡Ç½¤ÏÄã²¼¤¹¤ë¡¥¤Þ¤¿¶Ëü¤Ë¿´ÉÔÁ´¤Ë¤Ê¤ë¤ÈTÇÈ¤Ï °ìÃ×(concordant)¤ËÊѲ½¤¹¤ë¡¥¤½¤ÎÍýͳ¤ÏÉÔÌÀ¡¥ Åŵ¤¼´¤Ï¿åÊ¿²½¤¹¤ë¤ÈQRSÉý¤Ï¹­¤¯¤Ê¤ê¡¤¼ý½Ìǽ¤ÎÄã²¼¤ò¼¨¤·¡¤ ¿âľ²½¤¹¤ë¤È¿´¶Ú¾É¤òȼ¤¤Î¾¿´¼¼¤¬³ÈÄ¥¤¹¤ë(BB p.130)¡¥ BB p.128 fig 10.13¤è¤ê º¸µÓ¥Ö¥í¥Ã¥¯¤Þ¤È¤á Luna: Clinical Electrocardiography p.174 º¸µÓ¥Ö¥í¥Ã¥¯¤ÎΩÂÎ¥Ù¥¯¥È¥ë¿Þ¡¥ 20180729103030.png Á°ÊÉÃæ³Ö¹¼ºÉ¤Ç¤Îº¸µÓ¥Ö¥í¥Ã¥¯¡¥ Ãæ³Ö¹¼ºÉ¤¬¤Ê¤±¤ì¤ÐV1¤ËrÇȤϤʤ¯¡¤V6¤Ç¤ÏÃæ³Ö¤È¿´ÀíÉô¤«¤é¤Î¶½Ê³¤Î¤¿¤á¤ËV6¤ËÌî¤Ã¤Á¤¬°µÀ©¤¹¤ë¡¥ Ãæ³Ö¹¼ºÉ¤¬¤¢¤ì¤Ð¡¤V1¤ËrÇȤ¬À¸¤¸¤ë¤¬±¦¼¼Â¦Êɶ½Ê³¤Ç¤¢¤ë¡¥¤Þ¤¿¡¤V6¤ËqÇÈ¡¤ÆóÃʤÎRÇȤ¬È¯À¸¤¹¤ë¡¥ IMG_20190922_0002.png
¹âTÇÈÌܼ¡¤ËÌá¤ë¡£
Àµ¾ïTÇȤÎÇȹâ¤Ï»Í»èͶƳ¤Ç¤Ï6mm°Ê²¼¡¤¶»ÉôͶƳ¤Ç¤Ï12mm°Ê²¼¤Ç¤¢¤ê¡¤¤½¤ì°Ê¾å¤Ç¤¢¤ì¤Ð¹âTÇȤǤ¢¤ë¡¥RÇȤޤ¿¤ÏSÇȤÎ2/3°Ê¾å¤ò¹âTÇȤȤ¤¤¦¡¥¤µ¤é¤Ë¡¤º¸±¦ÂоΤǤ¢¤ë¤³¤È¤¬µá¤á¤é¤ì¤ë (p.325)¡¥ positive ÍÛÀ­TÇÈ negative ±¢À­TÇÈ flipped ȿžTÇÈ (ËÜÍèÍÛÀ­TÇȤʤΤ˱¢À­TÇȤˤʤ俾ì¹ç¤ò¼¨¤¹) ¹âK·ì¾É¡§ p.504 ecg 16-6. ¥Æ¥ó¥È¾õTÇȤÏ5.5mEq/L¤Ç¸«¤é¤ì¤ë¡¥ PR´Ö³Ö¤Î±äŤÏ6.5mEq/L°Ê¾å¡¤7.0mEq/L¤Ë¤Ê¤ë¤ÈPÇȤθº¼å¡¤ 8.8mEq/L°Ê¾å¤À¤ÈPÇȤϾüº¤¹¤ë¡¥ ·ìÞùK+¥¤¥ª¥óÇ»ÅÙ¤¬8.2mEQ/L¤ÎËýÀ­¿ÕÉÔÁ´´µ¼Ô¤Î¿´ÅÅ¿Þ¡¥
µðÂç±¢À­TÇÈÌܼ¡¤ËÌá¤ë¡£
³ÈÄ¥À­¿´¶Ú¾É(ÂýÄÛ)¡¤¿´ÆâËì²¼¹¼ºÉ¡¤Ç¾·ì´É¾ã³² WJC-7-86.pdf
¿´ÈîÂç¤È¿´³ÈÄ¥Ìܼ¡¤ËÌá¤ë¡£
Luna: ECG text p.124 ¿´ÈîÂç¤Ï¿´¶Ú¤ÎÈîÂç¤Ç¿´³Æ¹»¤Ï¿´¼¼ÍÆÀѤγÈÂç¤Ç¤¢¤ë¡¥ ±¦¼¼ÈîÂç¤Ç¤ÏV1¤ÎRÇȤÎÁý¹â¤ÈÈóÂоÎTÇȤÎȿž¡¥ º¸¼¼ÈîÂç¤Ç¤ÏV5-6¤ÎRÇȤÎÁý¹â¤ÈÈóÂоÎTÇȤÎȿž¡¥ ±¦¼¼³ÈÄ¥¤Ç¤ÏV1¤ÎrSR'¤ÎÁý¹â¤ÈÈóÂоÎTÇȤÎȿž¡¥ º¸¼¼ÈîÂç¤Ç¤ÏV6¤ÎqR¤È¹â¤¤ÂоÎÀ­TÇȤò¼¨¤¹¡¥ RVE: right ventricular enlargement
º¸¼¼ÈîÂçÌܼ¡¤ËÌá¤ë¡£
V1¤Þ¤¿¤ÏV2¤ÎSÇÈ+V5¤ÎRÇÈ > 35mm ¤¤¤º¤ì¤«¤Î¶»ÉôͶƳ > 45mm aVF > 20mm aVL > 11mm I > 12mm V4, V5, V6¤Ç±¢À­TÇÈ º¸¼¼³ÈÄ¥ ±¢À­TÇȤǤʤ¯¤Æ¤â¤è¤¤¡¥ V5, V6¤ÇST´Ù±ú¤ÎÍÛÀ­TÇÈ II, III, aVF¤Î1mm°Ê²¼¤Î¾®¤µ¤ÊQÇÈ cf ecg 11-4, 11-5
±¦¼¼ÈîÂçÌܼ¡¤ËÌá¤ë¡£
LPFB¤Î½ü³°¿ÇÃǤËɬÍס¥ RVH¤Ï´ðËÜŪ¤Ë3Ä̤ê¤Î¿´ÅÅ¿ÞÇÈ·Á¤¬¤¢¤ë¡¥BB p.73 Á´¤Æ¤Î¥¿¥¤¥×¤Ç Axis > 90¡ë¤Ï¶¦Ä̤¹¤ë¡¥ 1) V1¤ÎR/S > 1. TÇȤϥ¹¥È¥ì¥¤¥ó¤Ë¤Ê¤ë¡¥ 11-12 ±¦¼´Êа̡¤È¿»þ·×²óž¡¤V4-6¤ÇSÇȤϤʤ¤¡¥V1¤ÏRS·¿¤Ç¤¢¤ë¡¥ 11-13 V1¤ÎR/S¤Ï¾®¤µ¤¤¤¬¡¤V2¤ÇR/S >1, DDX¤Î·ë²Ì±¦¼¼ÈîÂç¤ÈȽÃÇ¡¥ V1-3¤Î¥¹¥È¥ì¥¤¥óT¤â±¦¼¼ÈîÂç¤ÎȽÃǺàÎÁ¤Ë¤Ê¤ë¡¥ BB p.73, fig7.16 BB p.74, fig7.16A GE #41 V1¤ò³ÈÂ礷¤Æ¸«¤ë¤ÈrsR'¤ÇIRBBB¤ÈƱ¤¸À­¼Á¤Ç¤¢¤ë¡¥¤·¤«¤·QRS¤Ï0.9sec¤Ç¤¢¤ë¤«¤é IRBBB¤Ç¤Ï¤Ê¤¤¡¥V6¤Ç¤Ïº¸¼¼¶½Ê³¤Î¸å¤Ë±¦¼¼¶½Ê³¤¬È¯À¸¤¹¤ë¡¥ 2) V1¤¬qR¤ÇRÇȹ⤬7mm°Ê¾å¡¥ IRBBB¤È¶èÊ̤¹¤ëɬÍפ¬¤¢¤ë¡¥V6¤ÎSÇȤ¬¥·¥ã¡¼¥×¤Ç¤¢¤ë¤³¤È¤ò³Îǧ¤¹¤ë¡¥ IͶƳ¤ÇrSÇÈ¡¤¤¹¤Ê¤ï¤Á±¦¼´Êа̤Ǥ¢¤ë¡¥ BB p.74, fig7.16B AF¤À¤«¤éÇÙÀ­P¤Î¿ÇÃǤ¬¤Ç¤­¤Ê¤¤¡¥ GE #309 ¼´>90¡¤»Í»è¶»ÉôÄãÅÅ°Ì¡¤V1¤ÏqR¡¤V2-4¤ÏqrS, V5-6¤ÏRS¡¥COPD¤Î±¦¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§4:1¤ÎAF¤«nodal¡¤RVH¡¥±¦¼´Êа̤ÈÄãÅṲ̋Ǥʤ±¤ì¤ÐIRBBB¤òÈÝÄê ¤¹¤ë¤³¤È¤¬¤Ç¤­¤Ê¤¤¡¥¶»Éô¤ÎSÇȤÎÉý¤ÏºÙ˦´ÖÅÁƳ¤È¤âÆɤá¤ë¡¥ 3) V1¤«¤éV6¤Þ¤ÇrSÇÈ¡¥V1¤ÏQSÇȤǤâ¤è¤¤¡¥ BB p.74, fig7.16B RVH BB p.74, fig7.16C RVH 1,2,3)¤òÄ̤¸¤ÆV6¤ÎSÇȤ¬¶¦Ä̤¹¤ë¡¥ º¸¼¼¤È±¦¼¼¤È¤ÎÎÏ´Ø·¸¤Ç±¦¼¼¤¬¾¡¤Ã¤¿¾õÂ֤ȹͤ¨¤ì¤ÐǼÆÀ¤Ç¤­¤ë¡¥ COPD(fig7.17)¤äS1S2S3·¿¤âƱ¤¸¸¶Íý¤Ç¤¢¤ë¡¥ 4) COPD¤Ç¤Ï¿´Â¡¤¬Å©¾õ¤Ë¤Ê¤ê¡¤¶¯¤¤ÇÙÀ­PÇȤÈÄãÅṲ̋ˤʤ롥ÆäËI¤Ï ¿¶Éý¤¬¤Ê¤¯¡¤´ðÀþ¤¬¾¯¤·¿¶Éý¤¹¤ë¤¿¤±¤Ç¤¢¤ë¡¥ ¶»ÉôͶƳ¤Î¿¶Éý¤â¾®¤µ¤¤¤¬¡¤V1¤ÇSÇÈ¡¤¤½¤Î¸å¡¤RÇȤÎÁý¹â¤¬¤ß¤é¤ì¤ë¤¬¡¤ ¿¶Éý¤ÏV3¤¬ºÇÂ硤V4°Ê¾å¤Ï¿´Â¡¤«¤é±ó¤¯¤Ê¤ë¤¿¤á¸º¿ê¤¹¤ë¡¥»þ·×²óž¤Ç¤¢¤ë¡¥ BB p.75, fig7.17 GE #42¤ÏV6¤Î¤ßRS¤Ç»Ä¤ê¤Î¶»Éô¤ÏrSÇȤǤ¢¤ë(ÇÙµ¤¼ð)¡¥ GE #198¤Î¶»Éô¤ÏrS¤Ç»Ï¤Þ¤êƱÍͤο¶ÉýÁý¸º¤¬¸«¤é¤ì¤ë¡¥ 5) Âç¿Í¤ÎS1S2S3·¿. ¤³¤Î¾ì¹ç¡¤Åŵ¤¼´¤ÏNE¤Ë¸þ¤«¤¦¡¥¤¹¤Ê¤ï¤ÁrSÇȤDZ¦¼´Êа̤ÈƱ¤¸¡¥ ¤½¤Î¤¿¤áaVR¤ÏqR¤Ë¤Ê¤ê¡¤ aVL¤ÏrSr'¤Ë¤Ê¤ë¡¥V1¤ÏqRÇÈ¡¥¶¯¤¤»þ·×²óž¤ÇV6¤ÎSÇȤϥ·¥ã¡¼¥×¡¥RÇȤÎÁý¹â¤Ï¤Ê¤¤¡¥ BB p.75, fig7.18 6) ÇÙ¹¼ºÉ¤ÏÉÑÌ®¤¬´ðËÜ¡¥S1Q3T3¤Ç¡¤¼´¤Ï90¡ë°Ê¾å¡¥¤½¤Î¤¿¤áaVR¤ÏqRÇȤˤʤ롥 V1¤ÏqRÇÈ¡¤V6¤ÏRSÇÈ¡¥¤½¤ÎSÇȤϥ·¥ã¡¼¥×¤Ç¤¢¤ë¡¥ BB p.76, fig7.19 7) ξ¿´¼¼ÈîÂç¤ÏÇÙÀ­PÇȤÈV1¤Î¹â¤¤RSÇȤǤ½¤Î¸å¤Ïº¸¼¼ÈîÂç¤Î·Á¾õ¤ò¼¨¤¹¡¥ ¼´¤Ïº¸¼¼ÈîÂç¤Î±Æ¶Á¤Ç90¡ë°Ê²¼¤Ç¤¢¤ë¡¥ BB p.76, fig7.20 final p.27 ¿Þ16»²¾È(ÇÙÀ­PÇȤâȼ¤Ã¤Æ¤¤¤ë)¡¥ Åŵ¤¼´¤Ï±¦¼´Êаܡ¥Î¾¿´ÈîÂç¤Ê¤é±¦¼´Êа̤ˤʤé¤Ê¤¤¡¥ ecg 11-27, ecg 11-28. TR¤¬V1¤äV2¤ÎÈ¿»þ·×²óž¤Ê¤é±¦¼¼ÈîÂç¤ä³ÈÄ¥¤ò¹Í¤¨¤ë¡¥ ST¤ÎµÕž¤¬¤Ê¤±¤ì¤Ð±¦¼¼³ÈÄ¥¡¥ ecg 13-30¤ÏÇÙÀ­PÇÈ¡¤±¦¼´Êа̡¤S1Q3T3¤Î±¦¼¼ÈîÂç¤ÎÍ×ÁǤò¤â¤Ä¤¬¡¤ V1¤ÇqR¤Ç¤¢¤ê¡¤°ì¸«±¦µÓ¥Ö¥í¥Ã¥¯¤Ë¸«¤¨¤ë¡¥¤³¤ÎqÇȤÏÃæ³Ö¶½Ê³¤Çº¸Êý¤Ë¸þ¤«¤¦¡¥ ³¤¯RÇȤϱ¦¼¼Á°Ì̤ο´¶Ú¶½Ê³¤¬¶¯¤¯¤Ê¤ê¡¤º¸¼¼¶½Ê³¤ÎSÇȤò¤·¤Î¤°·ë²Ì¤Ç¤¢¤ë¡¥ BB p.118, fig9.13¤ÏI¤Ç¡Ý¡¤aVF¤Ç¡Ü¤À¤«¤é±¦¼´Êа̡¤II,III,aVF¤ÇÇÙÀ­PÇÈ¡¤ ¶»ÉôV1¤Ç¾®¤µ¤ÊQSÇÈ¡¤v2¡ÁV6¤Þ¤ÇrSÇȤÇRÇȤÎÁý¹â¤â¤Ê¤¤¡¥ ¶¯¤¤»þ·×²óž¤Ç¤¢¤ë¡¥¤·¤«¤·¡¤±¦¼¼ÈîÂç¤È¿ÇÃǤ·¤Æ¤¤¤ë¡¥ V1¤Þ¤¿¤ÏV2¤ÎR/SÈ椬1°Ê¾å¡¥ V1¤Þ¤¿¤ÏV2¤¬¥¹¥È¥ì¥¤¥óTÇȤǵÕž¡¥ V6¤Ï¿¼¤¤SÇȤ⤢¤ì¤Ð̵¤¤¾ì¹ç¤â¤¢¤ë¡¥cf ecg 11-12. Á°ÊÉÃæ³Ö¹¼ºÉ¤ÇV1¤ÎrÇȤ¬QÇȤˤʤë¤È¡¤¤½¤Î¸å¤Î±¦¼¼ÈîÂç¤ÇV1¤ÎRÇȤϾ®¤µ¤¯¤Ê¤ë¡¥ cd ecg 11-13. ´ðËÜŪ¤Ë¤Ï¡§ º¸¼¼ÈîÂç¤ÈƱÍͤ˹âÅÅ°Ì¡¤ST¥»¥°¥á¥ó¥È¤Ï¥¹¥È¥ì¥¤¥óµÕžTÇȤǤ¢¤ë¡¥ º¸¼¼¥Ö¥í¥Ã¥¯¤Çº¸¼¼ÈîÂç¤Î¿ÇÃǤ¬¤Ç¤­¤Ê¤¤¤Î¤ÈƱÍͤˡ¤ ±¦µÓ¥Ö¥í¥Ã¥¯¤Ç¤Ï±¦¼¼ÈîÂç¤Î¿ÇÃǤϤǤ­¤Ê¤¤¡¥
BERÌܼ¡¤ËÌá¤ë¡£
Benign Early Repolarisation. ÎÉÀ­Áá´üºÆʬ¶Ë¡¥ ¼ãǯÃËÀ­¤Ë¿¤¤¡¥Osborn¤È»÷¤¿¥Î¥Ã¥Á¤¬QRS¤Ë³¤¤¤Æ¸«¤é¤ì¤ë¡¥ JÇȤޤ¿¤ÏJÅÀ¤Ï¾å¾º¡¤¾å¤Ë±ú¤ÎST¥»¥°¥á¥ó¥È¤ÇTÇȤÏÈóÂоΤǹ⤤¡¥ There is elevation of the J point The T wave is peaked and slightly asymmetrical The ST segment and the ascending limb of the T wave form an upward concavity The descending limb of the T wave is straighter and slightly steeper than the ascending limb ¥Î¥Ã¥ÁÉÕ¤­¤ÎST¥»¥°¥á¥ó¥È¤ò"fish fook" patern¤È¤¤¤¦¡¥ Ì®¤¬Á᤯¤Ê¤ë¤ÈSTE¤¬²¼¤¬¤ê¡¤²þÁ±¤¹¤ë¡¥ ¶»ÉôÄˤ¬¤¢¤ê¡¤¿´³°Ëì±ê¤äAMI»÷¤¿ÇÈ·Á¤ò¤¹¤ë¡¥ ¿´³°Ëì±ê¤Ç¤ÏPR¥»¥°¥á¥ó¥È¤ÎÄã²¼¤¬¤¢¤ë¤¬¡¤BER¤Ë¤Ï¤Ê¤¤¡¥12 Lead p.129, ECG 10-1. 50ºÍ°Ê¾å¤Ë¤Ê¤ë¤ÈSTE¤Ï¸º¾¯¤·¡¤AMI¤ò¹Íθ¤¹¤ë¡¥70ºÍ°Ê¾å¤ÎBER¤Ïµ©¤Ç¤¢¤ë¡¥ ½Ðŵ¡§34_368.pdf BER(Benign Early Repolarisation)
ÈóQÇȹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
akiyamalecture11.pdf Non Q-Wave MI ¶»ÄˤȹÚÁǾ徺¤¬¤¢¤Ã¤Æ°Û¾ïQÇȤ¬È¯À¸¤·¤Ê¤¤¹¼ºÉ¡¥ Evolving ST-T changes may include any of the following patterns: * Convex downward ST segment depression only (common) * Convex upwards or straight ST segment elevation only (uncommon) * Symmetrical T wave inversion only (common) * Combinations of above changes Non-Q Wave MI GE #283 GE ÈóQÇȹ¼ºÉ
°Û¾ïQÇÈÌܼ¡¤ËÌá¤ë¡£
2019ǯ 9·î 11Æü ¿åÍËÆü 14:56:39 JST °Û¾ïQÇȤÎÀ®°ø¡§ ½¾Íè¤Î¹Í¤¨Êý¡§ Q1.png ¿ÞA¡§Àµ¾ï¤Î¿´¶Ú¤Ç¤Ï¿´ÆâËì¦(¿´¼¼Æâ¹Ð)¤Ç¤Ï1¤Ë¼¨¤¹QS·¿¤Îæʬ¶ËÅṲ̋¬Â¬Äꤵ¤ì¡¤ ¿´³°Ë즤ǤÏ6¤Ë¼¨¤¹R·¿¤Îæʬ¶ËÅṲ̋¬ÆÀ¤é¤ì¤ë¡¥¿´¶ÚÆâ¤Ç¤Ï2¡Á5¤Ë¼¨¤¹¤è¤¦¤Ë rÇȤ¬¼¡Âè¤ËÂ礭¤¯¤Ê¤ëÃæ´Ö·¿¤ÎÇÈ·Á¤¬´Ñ¬¤µ¤ì¤ë¤È¹Í¤¨¤é¤ì¤ë¡¥ ¿ÞB¡§´ÓÊÉÀ­¹¼ºÉ¤Ç¤Ï¹â±ü¿´¶Ú¤¬²õ»à¤·¤Æ¤¤¤ë¤¿¤á¿´³°Ëì¦ÅṲ̋Ͽ´ÆâËì¦ÅṲ̋¬ ľÀÜϳÅŤ¹¤ë¤¿¤á¤Ë°Û¾ïQÇȤȤʤ롥¹¼ºÉÉô°Ì¤È¤Î¶­³¦Éô°Ì¤Ç¤ÏQR·¿¤È¤Ê¤ë¡¥ ¿ÞC¡§¿´ÆâËì¹¼ºÉ¤Ç¤¢¤ê¡¤¹¼ºÉ¤¬¤Þ¤À¤é¤Ë¿´³°Ë즤˵ڤó¤Ç¤¤¤ë¾ì¹ç¤ÏQr·¿¤È¤Ê¤ë¡¥ ¿ÞD¡§¿´ÆâË즤è¤êÃÇÊÒŪ¤Ê¹¼ºÉ¤¬¿´³°Ë즤˵ڤó¤Ç¤¤¤ë¾ì¹ç¤ÏÀµ¾ï¿´¶ÚÎ̤¬¾¯¤Ê¤¯¤Ê¤ë ¤¿¤á¤ËRÇȤÎÇȹâÄ㤯¤Ê¤ë¡¥ ¹Í»¡¡§ ¤³¤Î¹Í¤¨Êý¤ÏWilson¤ÎÄ󾧤·¤¿ The theory of electrical window¤Ë¤è¤ë¡¥ ºÙ˦¤ÏÀµ¾ï¾õÂ֤Ǥ¢¤ì¤Ð»ñ¼ÁÆó½ÅËì¤Çʤ¤ï¤ì¡¤Åŵ¤Àä±ïÅÙ¤ÏÈó¾ï¤Ë¹â¤¤¡¥¤·¤«¤· ºÙ˦»à¤Ê¤É¤Î¾ã³²¤¬È¯À¸¤¹¤ë¤Èº¸Ë¼Ëì¤ÎÀä±ïÀ­¤¬Äã²¼¤·¡¤¿´ÆâË즤«¤é¿´³°Ë즤ؤΠÅŵ¤ÅÁƳÀ­¤¬È¯À¸¤·¡¤QSÇȤ¬¤½¤Î¤Þ¤Þ¿´³°Ë즤ǬÄꤵ¤ì¡¤°Û¾ïQÇȤˤʤë¤È¤¤¤¦ ¹Í¤¨¤Ç¤¢¤ë¡¥ ¤·¤«¤·¡¤ËÜÅö¤Ë¿´ÆâËì¦ÅṲ̋ÏQS·¿¤Î¥Ñ¥ë¥¹ÇÈ·Á¤Ç¤¢¤í¤¦¤«¡¥¥«¥Æ¡¼¥Æ¥ëÅŶˤò ÁÞÆþ¤·¡¤¡Üü»Ò¤Ç¬Äꤹ¤ë¤ÈQSÇȤ¬´Ñ¬¤µ¤ì¤ë¤¬¡¤¡Ý¶Ë¤ÏÂÎɽ¤ËÁõÃ夷¤¿ÅŶˤǤ¢¤ë¡¥ ¤·¤¿¤¬¤Ã¤Æ¡¤¤³¤Îξü»Ò´Ö¤ÎÅŰ̺¹¤ÇQSÇÈ·Á¤¬´Ñ¬¤µ¤ì¤ë¤Ë²á¤®¤º¡¤¿¿¤Î¿´¹ÐÆâÅÅ°Ì¤Ï ¿´¶Ú³èÆ°ÅṲ̋ÎȿžÇÈ·Á¤Ç¤¢¤ë¤È¹Í¤¨¤ë¤Ù¤­¤Ç¤¢¤ë¡¥ ÅÄÃæ¤Î¹Í¤¨Êý¡§ ¿´¶ÚºÙ˦¤¬¹¼ºÉ¤Ë¤è¤ê»é¼ÁÆó½ÅËì¤È¤·¤Æ¤Îµ¡Ç½¤¬¤Ê¤¯¤Ê¤ë¤È ³èÆ°ÅṲ̋¬¾Ã¼º¤¹¤ë¤È¤È¤â¤ËÅŵ¤ÅÁƳÅÙ¤¬Áý²Ã¤¹¤ë¡¥ ½¾¤Ã¤Æ¾ã³²¤òÌȤ줿¿´ÆâË즿´¶Ú¤ÇȯÀ¸¤¹¤ë¿´¹ÐÆâÅṲ̋¬¿´³°Ë즤ËϳÅŤ¹¤ë¡¥ ¤³¤ì¤¬°Û¾ïQÇȤȤ·¤Æ¸¡½Ð¤µ¤ì¤ë¡¥´ÓÊÉÀ­¹¼ºÉ¤Ë¤Ê¤é¤Ê¤±¤ì¤Ð°Û¾ïQÇÈ¤Ë¤Ï ¤Ê¤é¤Ê¤¤¡¥¿Þ¤Ç¼¨¤¹¤È°Ê²¼¤Î¤È¤ª¤ê¤Ë¤Ê¤ë¡¥ infarc.png °Û¾ïQÇÈȯÀ¸¥á¥«¥Ë¥º¥à¡¥ ¿Þ¡§°Û¾ïQÇȤÎȯÀ¸µ¡½ø¡¥ 1/4ÂʱߤϿ´¼¼¤ÎÃÇÊÒ¤ò¼¨¤·¡¤³¥¿§¤Ï´ÓÊÉÀ­¹¼ºÉÉô°Ì¤ò¼¨¤¹¡¥¿´ÆâË즺Ù˦³°ÅṲ̋ò ÀÖÀþ¡¤¿´³°Ë즺Ù˦³°ÅṲ̋òÀÄÀþ¤Ç¼¨¤¹¡¥¤Þ¤¿¹¼ºÉÉô°Ì¤è¤êϳ¤ì¤Ç¤ë ¿´ÆâË즺Ù˦³°ÅṲ̋ÏÀÖÇËÀþ¤Ç¼¨¤¹¡¥±¦¿Þ¤Ï¤½¤ì¤¾¤ì¤ÎȿžÇÈ·Á¤ò»þÁê¤ò ¹ç¤ï¤»¤Æ¾å¤è¤ê¿´ÆâË즡¤¿´³°Ëì¦ÅÅ°Ì¡¤¤½¤Î°ú¤­»»ÇÈ·Á¤¬ÂÎɽ¿´ÅſޤȤʤ롥 ¿´³°Ë즤Î2ÇÈ·Á¤ÏÊÂÎó¤Ë²ÙÅŤµ¤ì¡¤¤Þ¤¿¿´ÆâËì¦ÅṲ̋è¤êµÞ½Ô¤Ëɽ¤ì¤ë¤¿¤á¤Ë °ú¤­»»¤¹¤ë¤È±¢À­¤ÎQÇȤȤʤ롥¿´ÆâË즺Ù˦³°ÅṲ̋è¤êϳÅŤ¹¤ë¿´³°Ëì¦ÅṲ̋ΠÊý¤¬µÞ½Ô¤ÊΩ¾å¤ê¤ò¼¨¤¹¡¥ 12 Lead p.418¡§ ´ÓÊÉÀ­¹¼ºÉ¤Ç¤Ï²õ»à¤·¤¿¿´¶ÚÊɤ¬¡ÖÁë¡×¤Ë¤Ê¤Ã¤Æ¡¤ÂЦÊɤÎRÇȤòµÕ¸þ¤­¤Ë ´Ñ¬¤¹¤ë¡¥´ÓÊÉÀ­¹¼ºÉ¤Ç¤Ê¤¤¾ì¹ç¤Ç¤â1/3°Ê¾å¤Î²õ»àÁؤο¼¤µ¤¬¤¢¤ë¤È¡¤ ¤½¤ÎÉô°Ì¤ÎPerkinjeºÙ˦¤Î¶½Ê³¤Ï¤Ê¤¤¡¥¤½¤Î¤¿¤á¤ËÀ¸¤­»Ä¤Ã¤¿¿´¶Ú¤Ë¤Ï cell to cellÅÁÇÅ¡¤¤Ä¤Þ¤êºÙ˦´ÖÅÁƳ¤Ç¶½Ê³¤¬ÅÁ¤ï¤ë¡¥¤½¤ÎÃÙ±ä»þ´Ö¤Î ´Ö¡¤¼þ°Ï¤«¤éµÕ¸þ¤­¤Î¶½Ê³ÅÅή¤¬´Ñ¬¤µ¤ì¤ë¡¥ ¤¤¤º¤ì¤Ë¤»¤è¡¤TÇȵÕž¤ÎÀâÌÀ¤Ï¤Ê¤¤¡¥ 12 Lead p.207. °Û¾ïQÇÈ Signifificat Q wave I¤ÈaVL¤ÎqÇȤÏÀµ¾ï¤Ç¸«¤é¤ì¤ë¡¥¤â¤·0.03sec°Û¾ï¤Ê¤é°Û¾ï¤Ç¤¢¤ë¡¥ III¤ÎqÇȤÏÅŵ¤¼´¤¬¿åÊ¿¤Ë¸þ¤«¤¦¤È¸«¤é¤ì¡¤Àµ¾ï¤Ç¤¢¤ë¡¥ II¤äaVF¤ËqÇȤ¬¸«¤¨¤ë¤È°Û¾ïQÇȤǤ¢¤ë¡¥ QSÇÈ·Á¤ÏRÇȤ¬¤Ê¤¤¤¿¤á¤ËQÇȤ«SÇȤ«¤ò¶èÊ̤Ǥ­¤Ê¤¤¡¥¤·¤¿¤¬¤Ã¤ÆQSÇȤȤ·¤¿¡¥ º¸¼¼ÈîÂç¤Ë¤è¤ëÀµ¾ïqÇȤÎÎã¡¥ 9-17 IACD¤ÎLAE¤ÎÎ㡤III, aVF¤ÎQÇȤÏÉý¤¬¶¹¤¯°Û¾ï¤Ç¤Ï¤Ê¤¤¡¥ I¡¤aVL¤ËÂ礭¤Ê¥Î¥Ã¥Á¡¤IVCDefect¤«¡©º¸¼¼¹âÅṲ̋ÈI, V5-V6¤Î¥¹¥È¥ì¥¤¥óT¤Ç º¸Ë¼Éé²Ù¡¤º¸¼¼ÈîÂç¡¥
AMIÌܼ¡¤ËÌá¤ë¡£
final.pdf p.62 ¿Þ33 12 Lead¤Ç¤ÎAMI¤ÎʬÎà¡¥ Anterior Wll MI V3, V4 p.425 Anteroseptal MI V1, V2, V3, V4 p.426 Anteroseptal with Lateral Extention V1, V2, V3, V4, V5, V6 I, aVL p.431 Laeeral Wll V5, V6 LAD¤ÎÂгѻޤι¼ºÉ¡¥ Hight Lateral Wall I, aVL p.443 Inferior Wll II, III, aVF p.446 ±¦´§Æ°Ì®¤Î±Ô³Ñ»Þ¤Î¹¼ºÉ¡¥ Inferolateral AMI II, III, aVF, V5,V6 p.450 Apical AMI p.458
Á°ÊÉÃæ³Ö¹¼ºÉÌܼ¡¤ËÌá¤ë¡£
12 Lead p.425 Ãæ³Ö¤ÏV1,V2; Á°ÊɤÏV3,V4¡¥Â¦ÊɤÏV5,V6,I¡¥¹â°Ì¦ÊɤÏaVL¤Ç¤¢¤ë¡¥ Á°ÊÉÃæ³Ö¹¼ºÉ¤Ï»Í»èͶƳ¤Ë¥ß¥é¡¼¤Ê¤É¤Î±Æ¶Á¤Ï¤¢¤¿¤¨¤Ê¤¤¡¥ 15-1 V1¡ÁV5¤Þ¤ÇSTE¤Ç¿åÊ¿¡¥RÇȤϻĤäƤ¤¤ë¡¥aVL¤ÎSTE¡¤¤½¤Î¥ß¥é¡¼¤Ç II,III,aVF¤ÎSTD¡¥ 15-2 V1,V2,V3¤ÎQÇÈ¡¤¿åÊ¿¡¤¤â¤·¤¯¤Ï¾å¸þ¤­¤ÎSTE¡¥TÇȤÎÂоεÕž¤ÏV1¤«¤éV4¤Þ¤Ç¡¥ aVL¤ÎqÇȤÏÀµ¾ï¡¥ 15-3 STE¤ÏV1¡ÁV4¡¤°Û¾ïQÇȤÏV2¡ÁV4¡¤ÂоÎÀ­È¿Å¾T¤ÏV2¡ÁV4¡¥IRBBB¤ÇLAF¤Ç¤¢¤ë¡¥ II,III,aVF¤ÎQSÇȤϤ½¤Î¤¿¤á¤Ç¤¢¤ê¡¤°Û¾ïQÇȤǤϤʤ¤¡¥ ¤½¤Î¾Úµò¤Ë¿åÊ¿ST¤Ç¤¢¤ê¡¤AMI¤È¤·¤Æǧ¤á¤é¤ì¤Ê¤¤¡¥
Á°Êɹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
12 Lead p.425 GE #270, µÞÀ­Á°Êɹ¼ºÉ¡¤V2¡ÁV4¤ÎSTD¤ÈTÇÈÁý¹â¤¬¸«¤é¤ì¤ë¡¥ TÇÈÁý¹â¤Ï¿´³°Ë즿´¶Ú¤ÎÁá´üºÆʬ¶Ë¤Ë¸¶°ø¤¹¤ë¡¥ µ¤¤Ë¤¹¤ì¤Ð¡¤I¤ÎSTD¡¤II¤ÎSTE¡¤III¤ÎSTE¤ÈʿóTÇÈ¡¤aVF¤ÎSTE¡¤ aVL¤ÎSTD¤¬¸«¤¨¤ë¡¥
Á°ÊÉÃæ³Ö¦Êɹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
ŵ·¿Åª¤ÊÁ°ÊÉÃæ³Ö¡¤Â¦Êɹ¼ºÉ¡§V6¤ÎQS¥Ñ¥¿¡¼¥ó¤ÈI, aVL¤Î°Û¾ïQÇȤËÃí°Õ¡¥ II, III, aVF¤Ï¥ß¥é¡¼¥¤¥á¡¼¥¸¤ÇSTÄã²¼¤ò¼¨¤¹¡¥¸åÊɤÏÀµ¾ï¿´¶Ú¤Ç¤¢¤ë¡¥ IMG_20180724_0006a.png GE #249 IMG_20180724_0006a.png p.431. º¸´§Æ°Ì®¤ÎÊĺɤǤ¢¤ì¤Ð¡¤Á°²¼¹ß»Þ¤È²óÀû»Þ¤ÎÊĺɤˤʤ롥 15-4 V1¤ÏÀµ¾ï¡¤V2¡ÁV6¤Þ¤ÇSTE¤Î¹¼ºÉ¡¤¾®¤µ¤ÊqÇȤ¬¤¢¤ë¤¬¡¤Àµ¾ïÈϰϤ«¡¥ I,aVL¤ÎSTE¡¤¥ß¥é¡¼¤ÇIII,aVF¤ÎSTD¡¤¤·¤«¤·III¤¬ºÇ¤â¤Ä¤è¤¤¡¥¤³¤³¤Ë¤â qÇȤ¬¤¢¤ë¤¬¡¤Àµ¾ïÈϰϤ«¡© ²òÀâ¤Ç¤ÏqÇȤϰ۾ïQÇȤǤ¢¤ë¡¥Ä¶µÞÀ­¤ÎSTE¡¥ 15-5 V1¡ÁV4¤ÎSTE¤Ç¥É¡¼¥à¾õ¡¤V5¡ÁV6¤ÎÂоÎÀ­TÇȵÕž¡¥I,aVL¤ÎSTE¡¥ III,aVF¤Î¥ß¥é¡¼STD¡¥VͶƳ¤ÎRÇȤÏÊݤ¿¤ì¤Æ¤¤¤ë¡¥ ²òÀâ¤Ç¤ÏV5¤âSTE¤Ç¹¼ºÉ¥Ñ¥¿¡¼¥ó¡¥ 15-6 V1¡ÁV6¤Þ¤Ç¤Î°Û¾ïQÇȤÈSTE¡¥I,aVL¤ÎSTE¤ÈȿžTÇÈ¡¥II,III,aVF¤ÎSTD¤È¾å¸þ¤­ TÇÈ¡¥ ²òÀâ¤Ç¤ÏV1¤ËrÇȤ¬Â¸ºß¤¹¤ë¤«¤éQSÇȤǤϤʤ¤¡¥rSÇȤǤ¢¤ë¡¥ 15-7 V1¡ÁV5¤Þ¤Ç¤ÎSTE¡¤I,aVL¤ÎSTE¡¤II,III,aVF¤Î¥ß¥é¡¼¡¥ 15-8 Junctional P, I,aVL,V1¡ÁV6¤Þ¤Ç¤Î¾å¸þ¤­ST¥»¥°¤ÈSTE¡¥
¹â°Ì¦Êɹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
¦Êɹ¼ºÉ¤ÏV5-6, ¹â°Ì¦Êɹ¼ºÉ¤Ï I,aVL¤Î°Û¾ïQÇȤò¼¨¤¹¡£ 15-14 I, aVL¤ÎSTE¤ÈTȿž¡¤II, III, aVF¤ÎSTD¡¥V4-6¤ÏTȿž¤Î¤ß¡¥ BB p.118, fig 9.14 I¤ÈaVL¤ÇQS¥Ñ¥¿¡¼¥ó¡¤LPFB¤È´Ö°ã¤¨¤ë¡¥LPFB¤Ç¤ÏI¤ÈaVL¤ÏrS¤Ç¤¢¤ë¡¥ ¤³¤Î¾ÉÎã¤ÏV1¤ÇQr¡¤V2¡ÁV4¤Þ¤Ç°Û¾ïQÇÈ(QS¥Ñ¥¿¡¼¥ó)¤ò¤â¤Ä¡¥ ¶»ÉôͶƳ¤ËµÕžTÇȤϤʤ¯¡¤¾å¸þ¤­TÇȤǤ¢¤ë¡¥
²¼Êɹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
III¤ÎqÇȤϤ褯¸«¤é¤ì¤ë¤¬¡¤II¤ÎQÇȤ¬¸«¤¨¤ë¤È²¼Êɹ¼ºÉ¤Î²ÄǽÀ­¤¬¹â¤¤¡¥ LAFB¤Èʻȯ¤¹¤ë¤È¿ÇÃǤ¬Æñ¤·¤¤¤Î¤Ç¡¤rÇȤ¬Â¸ºß¤·¤Ê¤¤¤³¤È¤ò³Î¤«¤á¤ë¡¥ BB p.115, fig 9.6, II,III,aVF¤ÎTÇȤÏÁ´¤Æ¾å¸þ¤­¡¥ GE #28¤Ï²¼Êɹ¼ºÉ¤ÇV5,V6¤Ë°Û¾ïQÇȤè¤ê²¼ÊɦÊɹ¼ºÉ¡¥ ¸åÊɹ¼ºÉ¤¬È¼¤Ã¤Æ¤¤¤ë¤È¹Í¤¨¤ë¤È¡¤ V1,V2¤Î¹â¤¤RÇȤȤʤ뤬¡¤V2-V3¤ÎTÇȤÏÈóÂоΤÇÀµ¾ïÇÈ·Á¤Ç¤¢¤ë¡¥ old age¤Î¸åÊɹ¼ºÉ¤Îŵ·¿¤ËÍøÍѤǤ­¤ë¡¥ GE #28 #28 ¡ú final p.28¤Î¿Þ18¤Î²òÀâ¤Ï´Ö°ã¤Ã¤Æ¤¤¤ë¡¥ V4,V5,V6¤Ï¦Êɹ¼ºÉ¤Î°Û¾ïQÇȤǤ¢¤ë¡¥¤½¤Î¹¼ºÉ¤¬¸åÊɤ˵ڤӡ¤V1¤äV2¤Î¹â¤¤ RÇȤˤʤ롥V5,V6¤ËSÇȤ¬¤Ê¤¤¤³¤È¤Ï±¦µÓ¥Ö¥í¥Ã¥¯¤ä±¦¼¼ÈîÂç¤òÈÝÄꤹ¤ë¾Úµò¤Ç¤¢¤ë¡¥ 2018ǯ 7·î 12Æü ÌÚÍËÆü 16:51:08 JST final¤Î²òÀâ¤Ï´Ö°ã¤¤¤Ç¤Ï¤Ê¤¤¡¥¾å¸þ¤­¤Î´§À­TÇȤϤɤΤ褦¤ËÀâÌÀ¤¹¤ë¤Î¤« ʬ¤«¤é¤Ê¤¤¡¥GE #28¤ÎV!-V3¤ÏΩÇɤʴ§À­TÇȤǤ¢¤ë¡¥ 15-15 III¤ÈaVF¤Ë¶¯¤¤°Û¾ïQÇȤ¬¤¢¤ë¤¬¡¤STE¤Ê¤É¤ÎÊѲ½¤¬¤Ê¤¤¡¥QÇȤ¬ÉÕ°¤¹¤ëR¤Î 1/3°Ê¾å¡¤¤Þ¤¿¡¤0.03sec°Ê¾å¤Ç¤¢¤ì¤ÐÍ­°Ù¤È¤¹¤ë¡¥ÄĵìÀ­²¼Êɹ¼ºÉ¡¥ 15-16 V1¤ÈV6¤ÎÅŶ˴ְ㤤¡¤CRBBB¤Ë¿ïȼ¤·¤¿IWMI¡¥ II,III,aVF¤Î°Û¾ïQÇÈ¡¥¾å¤ËÆ̤ÎSTE¡¥ »²¾È¥Õ¥¡¥¤¥ë iwmi 9-13 IACD¤ÎLAE¤ÎÎ㡤II, III, aVF¤ËQÇÈ¡¥ÂоÎÀ­TÇÈȿž¡¥ II,III,aVF¤Ï¤ÏÂоÎÀ­È¿Å¾TÇÈ¡¤V1-6¤ÏÁ´¤ÆÈóÂоΥ¹¥È¥ì¥¤¥óTÇÈ¡¤ »Í»è¤Ï¿åÊ¿ST¡¤LVH¡¤º¸Ë¼Éé²Ù¡¤²¼Êɹ¼ºÉ ²¼ÊɦÊɤ˲䨤ƸåÊɹ¼ºÉ¤ÎÎã 11-22 II, III, aVF¤ÎQÇȤ¬¸²Ãø¡¤V4¡ÁV6¤ÎQÇÈ¡¤V1¤ÎRÇȤ¬¹â¤¯Éý¤¬¹­¤¤¡¥ ²¼ÊÉ¡¤Â¦Êɤι¼ºÉ¤ÎϢ³À­¤«¤é¸åÊɤι¼ºÉ¤¬¹Í¤¨¤é¤ì¤ë¡¥transition¤ÏV1¡ÁV2¡¥ I¤ÎqÇȤϾ¯¤·Â礭¤¯°Û¾ï¡¤aVL¤ÎqÇȤâ°Û¾ï¤Ç¹â°Ì¦Êɹ¼ºÉ¡¥ V1¤ÎRÇȤ¬¹â¤¯Éý¤¬¹­¤¤¤Î¤Ï¡¤¸åÊɹ¼ºÉ¤¬¤¢¤Ã¤¿¤³¤È¤ò¼¨¤¹¡¥ V1,V2¤ÎJÅÀ¤¬Äã²¼¤·¤Æ¤¤¤Ê¤¤¤³¤È¤Ï¡¤¸åÊɤÎST¾å¾º¤¬¤Ê¤¤¤³¤È¤ò¼¨¤¹¡¥ ²¼Êɹ¼ºÉ¤Î°Û¾ïQÇȤÏIII>aVF>II¤Î½ç¤Ë¾®¤µ¤¯¤Ê¤ë¤¬¡¤¹â°Ì¦Êɹ¼ºÉ¤¬ ȯÀ¸¤¹¤ë¤ÈI¤Ç°Û¾ïQÇȤ¬¸«¤¨¤ë¤¿¤áIII¤Ç¤Î°ú¤­»»¹â²½¤¬¾Ã¤µ¤ì¤ë¡¥ aVL¤ÎQÇȤθº¿ê¤ÏaVL=(i-III)/2¤À¤«¤éI¤ÎQÇȤ«¤éIII¤ÎQÇȤò°ú¤¯¤¿¤á¤Ë ¤µ¤é¤Ë¾®¤µ¤ÊQÇȤˤʤ롥
¸åÊɹ¼ºÉÌܼ¡¤ËÌá¤ë¡£
Posterior Wall AMI (PWMI) 12 Lead p.472 final p.28 ¿Þ18¡¥¤³¤ÎECG¤Î¶»ÉôͶƳ¤Ï GE #57¤È¤½¤Ã¤¯¤ê¤Ç¤¢¤ë¡¥ V9¤äV10¤ÇQÇÈ¡¤ST¾å¾º¡¤TÇȵÕž¤¬¤ß¤é¤ì¤ë¤¬¡¤V1,V2¤Ç¥ß¥é¡¼¥¤¥á¡¼¥¸¤È¤·¤Æ RÇȾ徺¡¤STÄã²¼¡¤¾å¸þ¤­TÇȤˤʤ롥 ¥ß¥é¡¼¥¤¥á¡¼¥¸¤È¤ÏRÇȤξ徺¡¤STÄã²¼¡¤¾å¸þ¤­¤ËÂоÎÀ­¤Î¶¯¤¤TÇȤò°ÕÌ£¤¹¤ë¡¥ RÇȤÏQÇȤεÕž¥¹¥Ñ¥¤¥¯¤¬²Ã»»¤µ¤ì¡¤Î©¾å¤ê¤¬Æߤ¯¡¤Çؤι⤤RÇȤˤʤ롥 PWMI¤ÈIWMI¤Ï¤è¤¯Ê»È¯¤¹¤ë¡¥ V1¤ÈV2¤ÎRÇȤ¬¹â¤¯Éý¤¬0.03Éðʾå¤Ê¤éÍ­½ê¸«¤Ç¤¢¤ë¡¥V1¤è¤êV2¤ÎÊý¤¬¸²Ãø¤Ë¸½¤ì¤ë¡¥ final p.51 ¿Þ23¡§ II, III, aVF¤ÏÀµ¾ï¤«¤«¤é²¼Êɹ¼ºÉ¤Ï¤Ê¤¤¡¥I, aVL¤Ë¾®¤µ¤ÊrÇȤ¬¤¢¤ê¡¤¤Þ¤¿SET¤¬ ¤Ê¤¤¤«¤é¡¤¹â°Ì¦Êɹ¼ºÉ¤Ï½ü³°¤Ç¤­¤ë¡¥±¦¼´ÊѰ̤λͻèÄãÅṲ̋Ǥ¢¤ë¡¥ V1-V3¤ÎSTD¤Ç¸åÊɹ¼ºÉ¤Î¥ß¥é¡¼¥¤¥á¡¼¥¸¤Ç¤¢¤ë¡¥V4-V6¤ÎRÇȤÎÁý¹â¤Ï¸«¤é¤ì¤º¡¤ PRP¤Ç¤¢¤ë¡¥V7-V9¤Ï¾®¤µ¤ÊQS¥Ñ¥¿¡¼¥ó¤ÇSTE¤Ç¤¢¤ë¡¥ 11-22¤Ï²¼ÊÉ¡¤Â¦ÊÉ¡¤¹â°Ì¦Êɤ˲䨤ƸåÊɹ¼ºÉ¤ò¼¨¤¹. 15-28 µÞÀ­¤ÇV1¡ÁV4¤Þ¤Ç¤Î¹â¤¤RÇÈ¡¤STÄã²¼¤È¾å¸þ¤­TÇÈ¡¥ ²¼Êɹ¼ºÉ¤Ï¤Ê¤¯¡¤ÆÈΩ¤·¤¿¸åÊɹ¼ºÉ¡¥¶»ÉôRÇȤÏV2¤¬ºÇ¤â¹â¤¯V6¤¬ºÇ¤âÄ㤤¡¥ º¸¼¼¤Î³èÆ°ÂÎÀѤθº¾¯¤È¹Í¤¨¤ì¤Ð¤è¤¤¡¥avR¤ÏqR¤Ç¤¢¤ë¡¥ÁêÂÐŪ¤Ë±¦¼¼³èÆ°¤¬ Í¥°Ì¤Ë¤Ê¤Ã¤Æ¤¤¤ë¡¥ ECG 15-28 15-29 II,III,aVF¤ÎQÇȤÈV1V2¤ÎRÇȾ徺¡¥¸Å¤¤²¼ÊɸåÊɹ¼ºÉ¡¥ ECG 15-29 GE #57 V1¡ÁV3¤Þ¤ÇRS¤Ç¹â¤¤TÇÈ¡¤V4¡ÁV6¤Ë½¾¤Ã¤ÆRÇȤϾ®¤µ¤¯V6¤ÏQS¤ÇSTE¡¥ ¤ß¤¿¤³¤È¤â̵¤¤ÇÈ·Á¡¥±¦¼¼ÈîÂç¡©»Í»èÄãÅÅ°Ì¡¥ ¸åÊɤÎAMI¡¥V1¤ÎRÇȤϸåÊɹ¼ºÉ¤Î¤¿¤á¡¤¤â¤·¸åÊɹ¼ºÉ¤ÇSTE¤¬È¯À¸¤¹¤ë ¤Þ¤Ç¤Î´Ö¤Ç¤¢¤ì¤Ð¡¤V1¡ÁV3¤Þ¤Ç¤Î¥ß¥é¡¼STD¤ÏȯÀ¸¤·¤Ê¤¤¡¥V5¡ÁV6¤ÎSTE¤Ï Àµ¤·¤¯AMI¤ò¼¨¤·¡¤II,III,aVF¤ÎÊѲ½¤Ï¤Ê¤¤¤«¤é±¦´§Æ°Ì®¤ÏÀµ¾ï¡¥ ½¾¤Ã¤Æ¡¤º¸²óÀû»Þ¤ÎÊĺɤˤè¤ë¦ÊɸåÊɹ¼ºÉ°Ê³°¤Ë¹Í¤¨¤é¤ì¤Ê¤¤¡¥ ²¼¿Þ¤ÏGE #57 ¾å¤ÈƱ¤¸¿´ÅſޤΥȥê¥ß¥ó¥°.
±¦¼¼¹¼ºÉÌܼ¡¤ËÌá¤ë¡£
²¼Êɹ¼ºÉ¤Ëȼ¤Ã¤ÆȯÀ¸¤¹¤ë¡¥ I, aVL¤Î¥ß¥é¡¼¸ú²Ì¤Ë¤è¤ëSTÄã²¼¡¥ GE #52 ±¦¼¼¹¼ºÉ¤Î²ÄǽÀ­¤¬¹â¤¤¡¥ final p.49, 12 Lead p.468 ²¼Êɹ¼ºÉ¤Ëȼ¤¦¤¬¡¤STE¤¬II¤è¤êIII¤¬¹â¤¯¡¤¤Þ¤¿¡¤V1¤ÎSTE¤ÈV2¤ÎSTD¡¥ ¤è¤êV3¤ÎÊý¤¬STE¤¬¹â¤¤¤È±¦¼¼¹¼ºÉ¤ò¹Í¤¨¤ë¡¥ 14-12 hyperacute AMI¡¥V1¡ÁV3¤Ë¾®¤µ¤ÊrÇȤ¬¸«¤¨¤ë¡¥²¼Êɱ¦¼¼¹¼ºÉ¡¥ 14-20 IWMI¤ÏÁ´¤Æ·¤¦¤¬¡¤III¤ÎSTE¤¬¸²Ãø¡¤V1¤ÎST¥»¥°¤ÏÇÈÂǤäƤ¤¤ë¡¥ V2¤ÏSTD¡¤V3¤ÏSTD¤«¤é¾å¸þ¤ÎľÀþ¡¤T¤Ïʿó¡¥15-26¤Ë»÷¤Æ¤¤¤ë¡¥ 15-25 II,III,aVF¤Î°Û¾ïQ¤ÈSTE¡¤v2¤òÃæ¿´¤È¤¹¤ëSTE¤ÎÊèÀÐÍÍÇÈ·Á¡¥ ¤è¤¯¸«¤ë¤ÈV1¡ÁV3¤ÎrÇȤϸºß¤¹¤ë¡¥I,aVL¤ÏSTD¤ÇTÇÈȿž¡¥ 15-26 I,aVL¤ÎSTD¡¤II¤Î¾®¤µ¤ÊSTE¡¤QÇȤ⾮¤µ¤¤¡¥III¤ÏÂ礭¤ÊQÇȤÈÂ礭¤ÊSTE¡¥ aVF¤âQÇȤϾ®¤µ¤¤¤¬Â礭¤ÊSTE¡¥V1¤ÈV3¤ÏSTE¤Ç¤¢¤ë¤¬¡¤V2¤ÏSTD¤«¤é »³·Á¤ËSTE¤·¤Æ¤¤¤ë¡¥ 15-26 I,aVL¤ÏSTD¡¤II¤ÎÊѲ½¤Ï¾¯¤Ê¤¤¤¬III¤ÏSTE¡¤aVF¤Ï¾®¤µ¤ÊQÇȤÈSTE¡¥ V1¤ÏSTE¤À¤¬Àµ¾ï¤Ë¤â¸«¤¨¤ë¡¥V2¡ÁV5¤Þ¤ÇÇÈÂǤä¿ST¥»¥°¥á¥ó¥È¡¥ ¤³¤ì¤ÏRVI¤Î¿ÇÃÇ´ð½à¤Ë¤Ê¤¤¡¥±¦Â¦Í¶Æ³¤Î¥Ç¡¼¥¿¤Ç³ÎÄꤹ¤ë¡¥
¿´ÀíÉô¹¼ºÉÌܼ¡¤ËÌá¤ë¡£
l2 Liead p.458. ±¦´§Æ°Ì®Ëܴɤι¼ºÉ¤ÇȯÀ¸¤¹¤ë¡¥ II,III,aVF,V3,V4,V5,V6,¤½¤·¤ÆI,aVL¤Ë±Æ¶Á¤¹¤ë¡¥ II,III,aVF¤Ï±¦´§Æ°Ì®¸å²¼¹Ô»Þ¡¤ V3,V4¤Ïº¸´§Æ°Ì®Á°²¼¹Ô»Þ¡¤ V5,V6¤Ïº¸´§Æ°Ì®Á°²¼¹Ô»Þ¤ÎÂгѻޡ¥(¦Êɹ¼ºÉ) final p.62¤è¤ê. coronary.png 15-22 ¿´ÀíÉô¹¼ºÉ¡§I¡¤II¡¤III¤ÎSTE¡¥aVR¤ÎSTD¡¥aVL¤Ï¿åÊ¿¡¥V1¤ÎSTD¡¥V3-6¤Þ¤Ç¶¯ÅÙ¤ÎSTE¡¥ 15-23 ¿´ÀíÉô¹¼ºÉ¡§I¤Ï·ÐÅÙ¤ÎSTE¡¤II¡¤III¤ÎSTE¡¥aVR¤ÎSTD¡¥aVL¤ÏȿžTÇÈ¡¥¡¥V1¤ÏÀµ¾ï¡¥V2-6¤Þ¤Ç¶¯ÅÙ¤ÎSTE¡¥

¹¼ºÉ¡Ü¥Ö¥í¥Ã¥¯Ìܼ¡¤ËÌá¤ë¡£

RÇȤÎÁý¹âÉÔÎÉÌܼ¡¤ËÌá¤ë¡£
RÇȤÎÁý¹âÉÔÎÉ (poor r progression/reversed r progression) ²¼¿Þ¤ÏLAFB¤Ë¤è¤êPRP¤¬È¯À¸¤·¤Æ¤¤¤ë¤¬¡¤V2¡ÁV5¤Ç¤Î¥Î¥Ã¥Á¤ÏIVCD¤ò¼¨¤¹¡¥ IVCD GE #243
¿´¼¼áîÌܼ¡¤ËÌá¤ë¡£
¹¼ºÉ¸å2W¤¿¤Ã¤Æ¤âSTE¤¬Ìá¤é¤Ê¤±¤ì¤Ð¿´¼¼áî¤Ç¤¢¤ë¡¥Ä̾ïV5¡¤V6 ¤ÏSTE¤Ï¤Ê¤¯¡¤TÇȤϵÕž¤¹¤ë¡¥ Á°ÊÉ¿´¼¼áî Á°ÊÉ¿´¼¼áî1 GE #328¤è¤ê¡§ Á°ÊÉ¿´¼¼áî2 ¸åÊÉ¿´¼¼áî
¿´¶Ú¾ÉÌܼ¡¤ËÌá¤ë¡£
ECG library A-Z HCM ¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É(»³¸ý¾É¸õ·²) ¿´¶Ú¾É¿ÇÎÅ¥¬¥¤¥É¥é¥¤¥ó(2018ǯ²þÄûÈÇ)
ÉÂÂÖ¤ÎÎò»Ë¡§
1957ǯ¡¤Brigden¤¬ÀèÅ·À­¡¤ÊÛËì¾É¡¤µõ·ì¡¤¹â·ì°µÀ­ÊѲ½¤¬¤Ê¤¯¤Æ¿´ÈîÂ硤¿´³ÈÄ¥¤ò¤­¤¿¤¹¾ÉÎã¤ò¿´¶Ú¾É¤È¤è¤ó¤À¡¥º¸¼¼Î®½ÐÏ©¶¹ºõ¤òȯÀ¸¤¹¤ë¼À´µ¤È¤·¤ÆÆÃȯÀ­Èî¸üÀ­ÂçÆ°Ì®ÊÛ²¼¶¹ºõ¾É idiopathic hypertrophic subaoric stenosis (IHSS)¡¤ÈîÂç·¿ÊĺÉÀ­¿´¶Ú¾É hypertrophic obstructive cariomyopathy (HOCM)¤ÎÉÂ̾¤¬¤Ä¤±¤é¤ì¤¿¡¥¤½¤Î¸å¡¤Î®½ÐÏ©¶¹ºõ¤Ï¿´¼¼Ãæ³Ö¤Î°Û¾ïÈî¸ü¤Ë¤è¤ëÆó¼¡ÅªÊѲ½¤Ç¤¢¤ë¤È¹Í¤¨¤é¤ì¡¤ÈîÂç·¿¿´¶Ú¾É HCM¤¬ÄêÃ夷¤¿¡¥¿´¶Ú¾É¤ÎʬÎà¤È¤·¤Æ¤Ï¡¤
1¡¥³ÈÄ¥·¿¿´¶Ú¾É¡Êdilated cardiomyopathy; DCM)¡¤
2¡¥ÈîÂç·¿¿´¶Ú¾É¡Êhypertrophic cardiomyopahy; HCM)¡¤
3¡¥¹´Â«·¿¿´¶Ú¾É¡Êrestrictive cardiomyopathy; RCM)¡¤
4¡¥ºÅÉÔÀ°Ì®À­±¦¼¼¿´¶Ú¾É¡Êarrhythmogenic right ventricular cardiomyopathy¡Ë¡¤
5¡¥Ê¬ÎàÉÔǽ¤Î¿´¶Ú¾É¡Êunclassified cardiomyopathy) ¡¤
6. ÆÃÄê¿´¶Ú¾É¡Êspecific cardiomyopathies¡Ë¤È¤Ê¤ë¡¥

°ìÊý¡¤Ê¬»Ò°äÅÁ³Ø¤Î¿ÊÊâ¤Ë¤è¤ê¼¡¡¹¤È¿´¶Ú¾É¤ÎÉ°ø°äÅÁ»Ò°Û¾ï¤¬Æ±Äꤵ¤ì¤Æ¤¤¤ë8¡Ë¡¤9¡Ë¡¥HCM ¤Ç¤Ï¤³¤ì¤Þ¤Ç¤Ë¿´¶Ú¦Â¥ß¥ª¥·¥ó½Åº¿¡¤¿´¶Ú¥È¥í¥Ý¥Ë¥óT¡¤¿´¶Ú¥ß¥ª¥·¥ó·ë¹çÃÁÇòC¤Ê¤É¤Î¾¯¤Ê¤¯¤È¤â10¼ï¤Î¥µ¥ë¥³¥á¥¢¡Ê´ØÏ¢¡Ë°äÅÁ»Ò¤Ë200°Ê¾å¤ÎÆÍÁ³ÊÑ°Û¤¬Êó¹ð¤µ¤ì¤Æ¤¤¤ë¡¥³ÈÄ¥·¿¿´¶Ú¾É¤Ç¤â¥¢¥¯¥Á¥ó¡¤¥¸¥¹¥È¥í¥Õ¥£¥ó¤Ê¤É¤Î°äÅÁ»Ò°Û¾ï¤¬¤ß¤é¤ì¤ë¤³¤È¤¬Êó¹ð¤µ¤ì¤Æ¤ª¤ê¡¤¿´¶Ú¾É¤Ï¤â¤Ï¤ä¡È¸¶°øÉÔÌÀ¤Ê¿´¶Ú¼À´µ¡É¤È¤Ï¤¤¤¨¤Ê¤¯¤Ê¤Ã¤¿¡¥¤³¤Î¤è¤¦¤Ê¿ÊÊâ¤ò¤¦¤±¤ÆWHO/ISFC ¹çƱ°Ñ°÷²ñ¤ÎÄó°Æ¤¬1995ǯ¤Ë²þÄû¤µ¤ì¤¿¡¥





ÈîÂç·¿¿´¶Ú¾É
¿´¼¼ÃæÉôÊĺÉÀ­¿´¶Ú¾É



³ÈÄ¥·¿¿´¶Ú¾ÉÌܼ¡¤ËÌá¤ë¡£
³ÈÄ¥·¿¿´¶Ú¾É¤Ê¤é¤Ó¤Ë´ØÏ¢¤¹¤ëÆó¼¡À­¿´¶Ú¾É¤Î¿ÇÎŤ˴ؤ¹¤ë¥¬¥¤¥É¥é¥¤¥ó ¤è¤ê¡¥ ³ÈÄ¥·¿¿´¶Ú¾É¥Þ¥¯¥í ³ÈÄ¥·¿¿´¶Ú¾É¥ß¥¯¥í ÆÃȯÀ­¿´¶Ú¾É¤ËÃÖ¤±¤ë¿´¶ÚÀ¸¸¡Ê¼Ë¡¤ÎÉÂÍý·×Âà³ØŪ¸¡Æ¤
³ÈÄ¥·¿¿´¶Ú¾É¤Î¿´ÅÅ¿Þ¤ÎÆÃħ¡§
¡¡³ÈÄ¥·¿¿´¶Ú¾É¤ËÆðÛŪ¤Ê¿´Åſ޽긫¤Ï¤Ê¤¤¡¥¤·¤«¤·¤Ê¤¬¤é¡¤¿´¶Ú¤ÎÀþ°Ý²½¡¤¿´Ë¼¿´¼¼¤Î³ÈÄ¥¡¤»É·ãÅÁƳ·Ï¤Î¾ã³²¡¤¿´ÉÔÁ´Åù¤ËͳÍ褹¤ëÇÈ·ÁÊѲ½¡¤ÉÔÀ°Ì®¤¬Ç§¤á¤é¤ì¤ë¡¥Æä˺¸¼¼¤Î³ÈÄ¥¡¤Àþ°Ý²½¤¬¿Ê¹Ô¤¹¤ë¤È¡¤º¸¼¼¹âÅÅ°Ì¢·º¸¼¼ÈîÂç¡Ê³ÈÂç¡Ë¡¤r Çȸº¹â¡ÊÆäËV1¤«¤éV3 ͶƳ¤Îpoor r progression¡Ë¡¤°Û¾ïQÇÈ¡¤QRSÉý±äĹ¡¤º¸Â¦¶»ÉôͶƳ¤Ë¤ª¤±¤ëVAT±äĹ¡¤ µÓ»Þ¥Ö¥í¥Ã¥¯¡¤ ¿´¼¼Æâ¥Ö¥í¥Ã¥¯¡¤ ST-TÊѲ½¤Ê¤É¤¬½Ð¸½¤¹¤ë¡¥º¸¼¼¤Î³ÈÄ¥¤¬¤µ¤é¤Ë¿Ê¹Ô¤¹¤ë¤È¡¤QRSÉý¤¬0.12ÉäòĶ¤¨¡¤º¸µÓ¥Ö¥í¥Ã¥¯½ê¸«¤òÄ褹¤ë¤¬¡¤¤½¤ÎÇÈ·Á¤Ïº¸¼¼³ÈÂç¤òȼ¤ï¤Ê¤¤Ãæ¿õÀ­¤Îº¸µÓ¥Ö¥í¥Ã¥¯¤È¤Ï°Û¤Ê¤ê¡¤QRSÇȤËÊ£¿ô¤Înotch¤ò´Þ¤à¤è¤¦¤Ê°Û¾ï¤ÊÇÈ·Á¡ÊËö¾¿À­¤Îº¸µÓ¥Ö¥í¥Ã¥¯¡Ë¤È¤Ê¤ë¡¥¤Þ¤¿¡¤º¸¼¼¤ÎÀþ°Ý²½¤¬¶ËÅ٤˿ʹԤ¹¤ë¤È¡¤º¸¼¼¤Îµ¯ÅÅÎϤ¬Äã²¼¾Ã¼º¤·¤Æ¡¤º¸Â¦¶»ÉôͶƳ¤ÎRÇȤ¬ÃøÌÀ¤Ë¸º¹â¤·¡¤SÇȤ¬¼çÂΤζ»ÉôͶƳÇÈ·Á¤ò¼¨¤¹¡Ê±¦µÓ¥Ö¥í¥Ã¥¯Îã¤ò½ü¤¯¡Ë¤È¤È¤â¤Ë¡¤»Í»èͶƳ¤ÏÄãÅŰ̲½¤¹¤ë¤è¤¦¤Ë¤Ê¤ë¡¥°ìÊý¡¤±¦¼¼¤Î³ÈÂ硤°µÉé²Ù¤¬À¸¤¸¤ë¤È±¦Â¦¶»ÉôͶƳ¤ÇTÇȤ¬±¢Å¾²½¤·¡¤¤½¤ì¤¬¤è¤êÃøÌÀ¤Ë¤Ê¤ë¤ÈV4¡¤V5ͶƳ¤Þ¤ÇT±¢Å¾¤¬Çȵڤ¹¤ë¤¬¡¤Æ±»þ¤Ëº¸¼¼³ÈÂ礬¸ºß¤¹¤ë¤È¡¤¤½¤ÎÊѲ½¤ÏÌÜΩ¤¿¤Ê¤¯¤Ê¤ë¡¥

¡¡¿´Ë¼¤â˼¼¼ÊۤεÕή¤äº¸¼¼³ÈÄ¥Ëö´ü°µ¤Î¾å¾º¤Ëȼ¤Ã¤Æ³ÈÂç¤ÈÀþ°Ý²½¤¬À¸¤¸¡¤PÇÈÉý¤Î±äĹ¤äº¸Ë¼Éé²Ù½ê¸«¤òÄ褷¡¤¿´Ë¼À­´ü³°¼ý½Ì¡¤¿´Ë¼ºÙÆ°¡ÊAF¡ËÅù¤Î¿´Ë¼À­ÉÔÀ°Ì®¤¬½Ð¸½¤·¤Æ¤¯¤ë¡¥¿´¼¼´ü³°¼ý½Ì¤â¿´µ¡Ç½¤ÎÄã²¼¤È¤È¤â¤Ë¿ȯ¤¹¤ë¤è¤¦¤Ë¤Ê¤ê¡¤Ï¢È¯¤ä¿¸»À­´ü³°¼ý½Ì¤â½Ð¸½¤¹¤ë¡¥

¡¡³ÈÄ¥·¿¿´¶Ú¾É¤Ç¤Ï¼ç¤È¤·¤Æº¸¼¼¤ËÉÂÊѤòÍ­¤¹¤ë¤¿¤á¡¤¿´¼¼´ü³°¼ý½Ì¤ÎÇÈ·Á¤Ï±¦µÓ¥Ö¥í¥Ã¥¯¤òÄ褹¤ë¤³¤È¤¬Â¿¤¤¤¬¡¤¿´¥µ¥ë¥³¥¤¥É¡¼¥·¥¹¤ÇÃæ³Ö´ðÉô¤ËÉÂÊѤòȼ¤¦¾ì¹ç¤Ï¡¤±¦µÓ¥Ö¥í¥Ã¥¯¡Ê¤Þ¤¿¤Ïº¸µÓ¥Ö¥í¥Ã¥¯¡Ë¡Ü²¼Êý¼´·¿¤Î´ü³°¼ý½Ì¢·¿´¼¼ÉÑÇï¡ÊVT¡Ë¤¬À¸¤¸¤ë¡¥¡¥

¡¡¿´ÉÔÁ´¾õÂ֤Ǥϳµ¤ÍÉÑÌ®¤È¤Ê¤ë¤¬¡¤¤½¤ÎºÝ¤ËPÇÈ·Á¤¬°Û½êÀ­¿´Ë¼µ¯¸»¤ò¼¨¤·¤Æ¤¤¤¿¤ê¡Êƶ·ëÀᵯ¸»¡áI¡¤II¡¤ IIIͶƳ¤ÇPÇȤ¬ÍÛÀ­¡Ë¡¤¿ç̲Ãæ¤â100/ʬ¤òĶ¤¨¤ëƶÉÑÌ®¤òÄ褷¤Æ¤¤¤ë¾ì¹ç¤Ï¡¤ ¿´Ë¼ÉÑÇï¤äÉÔŬÀÚƶÉÑÌ®¡Êinappropriate sinus tachycardia¡Ë¤Ë´ð¤Å¤¯ÉÑ̮ͶȯÀ­¿´¶Ú¾É¤òµ¿¤¦32¡Ë¡¥¿´¶Ú¤ÎÊÑÀ­¤Ë¤è¤ê»É·ãÅÁƳ·Ï¤¬½ý³²¤µ¤ì¤ë¤È¡¤I¡ÁIIIÅÙ˼¼¼¥Ö¥í¥Ã¥¯¤òÀ¸¤¸¤ë¤¬¡¤¿´¥µ¥ë¥³¥¤¥É¡¼¥·¥¹¤Ç¤Ïɽé´ü¤«¤é˼¼¼¥Ö¥í¥Ã¥¯¤òȼ¤¤¤ä¤¹¤¤33¡Ë¡¥¡Ê12 ͶƳ¿´ÅÅ¿Þ¡§¥ì¥Ù¥ë4a¡¤¥°¥ì¡¼¥ÉA¡Ë

³ÈÄ¥·¿¿´¶Ú¾É1
V2¤ÎSÇÈ > 35mm¤À¤«¤éLVH¡¤±¦¼´Êа̤À¤«¤éξ¿´¼¼ÈîÂ硤LAE¡¤II¤ÎPÇȤ¬¹â¤¯RAE¡¥
V5,6¤ÎRÇȤ¬Ä㤤¤³¤È¤«¤éº¸¼¼¿´¶Ú¤Ï³ÈÄ¥¤È¹Í¤¨¤ë¡¥STÉý¤¬Ä¹¤¤¤³¤È¤è¤êÇï½Ð»þ´Ö¤Î±äŤ¬¹Í¤¨¤é¤ì¤ë¡¥·ë²Ì¤È¤·¤ÆQTC¤Ï°Û¾ï¤ËŤ¯¤Ê¤ë¡¥

³ÈÄ¥·¿¿´¶Ú¾É2
ŵ·¿Åª¤ÊLVH¥Ñ¥¿¡¼¥ó¡¤V1¤ÎPÇȤÏRAE¤ÈLAE¤¬¸«¤é¤ì¤ë¡¥RVH¤Î½ê¸«¤Ï¤Ê¤¤¤¬¥¨¥³¡¼¤è¤êξ¿´¼¼ÈîÂ礬³Îǧ¤µ¤ì¤¿¡¥QTc¤ÏŤ¤¡¥

³ÈÄ¥·¿¿´¶Ú¾É3
±¦¼´Êа̤Ⱥ¸¼¼ÈîÂç¡¥QRSÉý¤Ï¹­¤¯CLBBBÍͤǤ¢¤ë¤¬¡¤V6¤Ë¾®¤µ¤ÊqÇȤ¬¤¢¤ë¤¿¤á¤ËÅÁƳÃÙ±ä(IVCD)¤Ç¤¢¤ë¡¥²¼¹ß¤¹¤ëST¥»¥°¥á¥ó¥È¤Ï¥¹¥È¥ì¥¤¥ó¤«¥¸¥®¥¿¥ê¥¹¸ú²Ì¤«ÉÔÌÀ¡¥

³ÈÄ¥·¿¿´¶Ú¾É4
Af¤«¤éLBBBÍÍVT¤ÏDCM¤Ç¤è¤¯¸«¤é¤ì¤ë¡¥Îɤ¯¸«¤ë¤ÈR on T¤ÎVT¤Ç¤Ï¤Ê¤¯¡¤AF¤Ë¤è¤ëÉÑÌ®¤Ç¤¢¤ë¡¥


ÈîÂç·¿¿´¶Ú¾ÉÌܼ¡¤ËÌá¤ë¡£
ÈîÂç·¿¿´¶Ú¾É¤Î¿ÇÎŤ˴ؤ¹¤ë¥¬¥¤¥É¥é¥¤¥ó(2007)

ÈîÂç·¿¿´¶Ú¾É¥Þ¥¯¥í
ÈîÂç·¿¿´¶Ú¾É¥ß¥¯¥í
dagger.png
dagger2.png
dagger3.png
apical.png
apical2.png
apical3.png
apical4.png

HCM¤ÏÄ̾￴¼¼Ãæ³Ö¤ÎÈîÂç¤òȯÀ¸¤·¡¤¤½¤ì¤¬º¸¼¼Î®½ÐÏ©¤Ë¤Þ¤ÇÇȵڤ¹¤ë¤ÈÊĺÉÀ­ÈîÂç·¿¿´¶Ú¾É(HOCM 25%)¤È¤è¤Ö¡¥Æüì¤Ê·¿¤È¤·¤Æº¸¼¼¼«Í³ÊɤËÈîÂ礬µÚ¤Ö¤È¿´¼¼ÃæÉôÊĺÉÀ­¿´¶Ú¾É(20%)¡¢Ãæ³Ö¤Ç¤Ï¤Ê¤¯¿´ÀíÉô¤ÇÈîÂ礹¤ë¤È¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É(10%)¤È¤è¤Ó¡¤ÅìËÌ¥¢¥¸¥¢¿Í¤Ë¿¤¤¡¥

¡¡HCM ¤ÎÌóȾ¿ô¤Ë¾ïÀ÷¿§ÂÎÀ­Í¥À­°äÅÁ¤Î²È²Æâȯ¾É¤¬¤ß¤é¤ì¤ë¡¥¸ÉȯÎã¤ÎHCM ¤Î¤Ê¤«¤Ë¤Ï¤È¤ê¤ï¤±¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É¤¬Â¿¤¯´Þ¤Þ¤ì¡¤HOCM ¤Ï¾¯¤Ê¤¤¡¥ C·¿´Î±ê¥¦¥¤¥ë¥¹¡ÊHCV¡Ë¤ÏHCM ¤Î¸¶°ø¤È¤·¤Æ½ÅÍפǤ¢¤ë¤³¤È¤¬¼¨º¶¤µ¤ì¤Æ¤¤¤ë29¡Ë¡¥ HCM ¤Ç¤Ï³ÈÄ¥ÉÔÁ´¤¬¼çÉÂÂ֤ǡ¤¼ý½Ìǽ¤Ï°ìÈÌŪ¤Ë¤ÏÊÝ»ý¤µ¤ì¤Æ¤¤¤ë56¡Ë¡¤67¡Ë¡¥

¡¡º¸¼¼Î®½ÐÏ©¶¹ºõ HOCM ¤Ï¡¤HCM Á´ÂΤÎÌó25¡óÄøÅ٤Ȥµ¤ì¤Æ¤¤¤ë75¡Ë¡¥¼«³Ð¾É¾õ¤Ë¶»Äˤ¬Â¿¤¤¡¥¤·¤«¤·¡¤ °¡¾Ë»ÀÌô¤Ï HCM ´µ¼Ô¤ËÂФ·¤Æ¤Ï¶Ø´÷Ìô¤Ç¤¢¤ê¡¤¶»ÄˤËÂФ·¤Æ¤ÏŬÀڤʿÇÃǤ¬É¬ÍפǤ¢¤ë¡¥Æ°Ø©¤ÏÉÔÀ°Ì®¡¤ÉÑÌ®¤½¤·¤Æ¼ý½ÌÎϤÎÁýÂç¤Ê¤É¤Çǧ¤á¤é¤ì¤ë¡¥

¡¡Ä̾ïHCM ´µ¼Ô¤Ç¤Ï¾å¼¼À­¤¢¤ë¤¤¤Ï¿´¼¼À­ÉÔÀ°Ì®¤Ë¤è¤ëÆ°Ø©¤¬Â¿¤¤¡¥µ©¤Ê¤é¤º¡¤È¯ºîÀ­¿´Ë¼ºÙÆ°¤ä»ý³À­¿´Ë¼ºÙÆ°¤Î¤¿¤á¤ÎÆ°Ø©¤â¤¢¤ê¡¤¥Û¥ë¥¿¡¼¿´ÅſޤʤɤÇŬÀÚ¤«¤ÄÁá´ü¤Î¿ÇÃǤ¬É¬ÍפǤ¢¤ë¡¥

¡¡º¸¼¼¹âÅṲ̋ÎÉÑÅ٤ϡ¤¼ãǯHCM ¤Ç¤ÏÄ㤯121)¡¤À®¿Í¹âÎð¼Ô¤Ç¤Ï¹â¤¯¤Ê¤ë122)¡¥

ii¡Ë°Û¾ïQ ÇȤʤé¤Ó¤ËÃæ³ÖÀ­Q ÇȤξüº¡¡°Û¾ïQ ÇȤϡ¤¾®»ùHCM ¤ÎÌóȾ¿ô¤Ë121)¡¤À®¿Í¤Î25¡Á31¡ó¤Ëǧ¤á¤é¤ì¤ë80)¡¤117)¡¥°Û¾ïQÇÈ·ÁÀ®¤Ë¤Ï¡¤Ãæ³Ö¤ÎÉÔ¶ÑÅù¤ÊÈîÂç¤È¿´¶ÚÊÑÀ­¤Î2 ¤Ä¤ÎÀ®°ø¤¬¿ä¬¤µ¤ì¤ë127¡Ë¡¥Á°¼Ô¤ÏÈóÂоÎÀ­Ãæ³ÖÈî¸ü¤Ë¤è¤ë½é´ü¥Ù¥¯¥È¥ë¤ÎÉԶѹդǤ¢¤ê¡¤Éý¤Î¶¹¤¤¿¼¤¤Q ÇȤò¼¨¤·¡¤½é´üÃæ³Ö¥Ù¥¯¥È¥ë¤¬º¸¤«¤é±¦Êý¸þ¤Ë¸þ¤«¤¦¾ì¹ç¤Ë¤ÏV5,6 ¤Ë¡¤¾åÊý¸þ¤è¤ê¤Ç¤¢¤ì¤ÐII¡¤III¡¤aVF ¤ËQ ÇȤ¬·ÁÀ®¤µ¤ì¤ë¡¥Ãæ³Ö¤Ë¸Â¶É¤·¤¿¼ãǯÈîÂçÎã¤Ç°Û¾ïQ ÇȤÎÉÑÅÙ¤¬¹â¤¯117¡Ë¡¤ÈîÂ礬º¸¼¼¼«Í³ÊɤؿÊŸ¤¹¤ë¤«¡¤Ãæ³Ö¤Î¿´¶Ú¤ËÀþ°Ý²½¤¬À¸¤¸¤ì¤Ð¡¤Ãæ³Ö¥Ù¥¯¥È¥ë¤ÎÁêÂÐŪ¸º¾¯¤Ë¤è¤ê¡¤Q ÇȤϸº¹â¤·¡¤HCM ¤Î15¡ó¤Ç¤Ï¾Ã¼º¤¹¤ë¡¥¤Þ¤¿¡¤¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É¤ä±¦¼¼ÈîÂçÎã¤Ç¤Ï¡¤°Û¾ïQ ÇȤòȼ¤ï¤Ê¤¤128¡Ë¡¥¡¡¸å¼Ô¤Ï¡¤¿´¶Ú¤ÎÊÑÀ­¡¤Àþ°Ý²½¤Ë¤è¤ë¶É½ê¤Îµ¯ÅÅÎϾüº¤Ç¤¢¤ê¡¤RÇȤθº¹â¤È¤È¤â¤Ë¿·¤¿¤Ê°Û¾ïQ ÇȤ¬½Ð¸½¤¹¤ë¡¥¤³¤ÎQ ÇȤÏÉý¹­¤¤¤³¤È¤¬Â¿¤¯¡¤V4-6 ͶƳ¤Ë¤ß¤é¤ì¤ë¡¥ D-HCM (dilated phase of hypertrophic cardiomyopathy: ³ÈÄ¥ÁêÈîÂç·¿¿´¶Ú¾É)¤Ë¿¤¤¡¥

iii)¤½¤Î¾¤ÎQRS °Û¾ï
¡¡¼´Êа̤Ï20¢·30¡ó¤Ëǧ¤á¤é¤ì¡¤º¸¼´Êа̤¬Â¿¤¤¡¥¿´¼¼ÆâÅÁƳ¾ã³²¤Ï»É·ãÅÁƳ·Ï¤Î¾ã³²¤òÈ¿±Ç¤¹¤ë¡¥15¡ó¤ËWPW¾É¸õ·²¤Ê¤É¿´¼¼Áá´ü¶½Ê³¤¬¹çÊ»¤·129¡Ë-131¡Ë¡¤µ©¤ËÆÍÁ³»à¤Î¸¶°ø¤È¤Ê¤ë130¡Ë¡¥
b¡ËST-T ÊѲ½
¡¡ST²¼¹ß¤È±¢À­TÇȤÏ70¢· 95¡ó¤Ëǧ¤á¤é¤ì¤ë¡¥µ¡½ø¤È¤·¤Æ¤Ï¡¤¿´¼¼ÈîÂç¤Ëȼ¤¦¿´ÆâËì²¼¿´¶Ú¤ÎÁêÂÐŪ¿´¶Úµõ·ì¡¤ÈîÂç¿´¶Ú¤ÎºÆʬ¶Ë²áÄø¤ÎÃÙ±ä¤Ëȼ¤¦°ì¼¡À­ÊѲ½¡¤Ã¦Ê¬¶Ë²áÄø¤ÎÊѲ½¤Ëȼ¤¦Æó¼¡À­ÊѲ½¤Ê¤É¤¬¿ä¬¤µ¤ì¤ë¡¥¥¹¥È¥ì¥¤¥ó¥Ñ¥¿¡¼¥ó¤¬Â¿¤¤¤¬¡¤Äã²¼¤ÎÄøÅÙ¤ÏÈîÂç¤ÎÄøÅÙ¤ÈÁê´Ø¤·¤Ê¤¤¡¥

¡¡¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É¤Ç¸«¤é¤ì¤ëº¸Â¦¶»ÉôͶƳ¤Î¹âÅṲ̋òȼ¤¦µðÂç±¢À­TÇȤÏV3 ¢· 5¤òÃæ¿´¤Ë¡¤1.0mV°Ê¾å¤ÇÂоÎÀ­¤ò¼¨¤·¡¤¤·¤Ð¤·¤ÐST²¼¹ß¤ò¤ß132¡Ë¡¤¿´ÀíÉôÈî¸ü¤ÎÄøÅÙ¤¬¶¯¤¤¤Û¤É¿¼¤¯¤Ê¤ë133¡Ë¡¥¿´ÀíÉôÈîÂç·¿¿´¶Ú¾É¤Î70 ¡ó¤Ç¤Ï¡¤¹âÅṲ̋äµðÂç±¢À­TÇȤϷвá¤È¤È¤â¤Ë¸º¾¯¡¤¾Ã¼º¤·124¡Ë¡¤¤½¤Î¸¶°ø¤ÏÈîÂç¿´¶Ú¤ÎÊÑÀ­¡¤Àþ°Ý²½¤Ëȼ¤¦Âà¹ÔÀ­ÊѲ½¤È¹Í¤¨¤é¤ì¤ë¡¥

¡¡»þ¤Ë¡¤º¸Â¦¶»ÉôͶƳ¡¤II¡¤III¡¤aVF¡¤¤¢¤ë¤¤¤ÏI¡¤ aVLͶƳ¤Ë¡¤RÇȤθº¹â¤äÉý¤Î¹­¤¤°Û¾ïQ ÇȤòȼ¤¦ST ¾å¾º¤òǧ¤á¤ë¤³¤È¤¬¤¢¤ê¡¤¿´¶ÚÊÑÀ­¤Î¿Ê¹Ô¤¬¿ä¬¤µ¤ì¤ë 134¡Ë¡¥D-HCM ¤ä¿´ÀíÉô¿´¼¼áî¹çÊ»Îã¤Ë¤·¤Ð¤·¤Ð¤ß¤é¤ì¤ë¡¥

ÈîÂç·¿¿´¶Ú¾É1 Dagger-like Q Waves
ÈîÂç·¿¿´¶Ú¾É2 Giant T wave inversion
ÈîÂç·¿¿´¶Ú¾É3 Classic HCM with asymmetrical sptal hypertrophy
ÈîÂç·¿¿´¶Ú¾É4 ¾å¤ÈƱ¤¸Ê̤ÎÎã
ÈîÂç·¿¿´¶Ú¾É5
ÈîÂç·¿¿´¶Ú¾É6
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼3
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼2
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼4
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼5
ÈîÂç·¿¿´¶Ú¾É¥¨¥³¡¼6





WPWÌܼ¡¤ËÌá¤ë¡£
12%¤ÎWPW¤ÏPR´Ö³Ö¤¬Àµ¾ï¤Ç¤¢¤ë¡¥ memo ÉûÅÁƳϩ¤Î°ÌÃ֤Ϻ¸¼¼¼«Í³Êɤ¬ºÇ¤â¿¤¯55%¡¤ ¤Ä¤¤¤Ç¸åÊÉÃæ³Ö¤¬33%¡¤±¦¼¼¼«Í³Êɤ¬9%¡¤ ±¦¼¼Á°ÊÉÃæ³Ö¤¬3%¤ÈÊó¹ð¤µ¤ì¤Æ¤¤¤ë¡¥ (Wellens: p.80) GE #305¡§ °ì¸«V1¤ÇLBBB¡¤V6¤ÇRSÇȤÀ¤«¤éIVCD¤Î¤è¤¦¤Ë¸«¤¨¤ë¤¬¡¤V6¤ÎSÇȤϥ·¥ã¡¼¥×¤Ç¤¢¤ë¡¥ ¤·¤¿¤¬¤Ã¤Æ¡¤RBBB¤ÎV6¤Ç¤Ï¤Ê¤¤¡¥PQû½Ì»Í»èͶƳ¤Î¦¤ÇȤ«¤éB·¿¤ÎWPW¤Ç¤¢¤ë¡¥ ÅÁƳÉô°Ì¤Ï(3A)±¦¼¼¸åÊÉÃæ³Ö¤Ë¤Ê¤ë¡¥ ¿ÇÃÇ¡§final p.97. IMG_20170912_0002.pdf IMG_20170912_0002.pdf¤ÏGE #190¡¥²èÁü°­¤¯ºî¤ê¤Ê¤ª¤·¡¥ III¤ÈaVF¤Î¥Ç¥ë¥¿ÇȤϥǥ륿ÇȤǤϤʤ¤¡¥ P-Rû½Ì¤Ç°Û¾ïQÇȤÏWPW¾É¸õ·²¤È´Ö°ã¤¨¤Ê¤¤¤è¤¦¤Ë¤·¤Ê¤±¤ì¤Ð¤Ê¤é¤Ê¤¤¡¥ (12 Lead p.137¤è¤ê) Type A: V1¤Ç¾å¸þ¤­¦¤ÇÈ¡¤Á´¤Æ¤Î¶»ÉôͶƳ¤¬RÇȤˤʤ롥º¸¼¼(Kent«)¤ËÉûÅÁƳϩ¤¬¤¢¤ë¤«¤é ±¦µÓ¥Ö¥í¥Ã¥¯·¿¤Ë»÷¤ë¡¥ Type B: V1¤Ç²¼¸þ¤­¦¤ÇÈ¡¤º¸Â¦¶»ÉôͶƳ¤Ï¾å¸þ¤­¤ÎRÇȤˤʤ롥±¦¼¼¤ËÉûÅÁƳϩ¤¬¤¢¤ë¤«¤é º¸µÓ¥Ö¥í¥Ã¥¯·¿¤Ë»÷¤ë¡¥ GE #186: ´Ö·çWPW¡¥ Type C: V1¤«¤éV4¤Þ¤Ç¤Ï¾å¸þ¤­¡¤V5, V6¤Ï²¼¸þ¤­SÇÈ¡¤µ©¤Ç¤¢¤ë¡¥ Type B¤ÎII, III, aVF¤Î±¢À­¦¤ÇȤϿ´¶Ú¹¼ºÉ¤Î°Û¾ïQÇȤȴְ㤨¤ä¤¹¤¤¡¥ pseudoinfarct¤È¤¤¤ï¤ì¤Æ¤¤¤ë¡¥Type A¤Î¹â¤¤RÇȤϸåÊɹ¼ºÉ¤È´Ö°ã¤¨¤ä¤¹¤¤¡¥ IVCD¤È´Ö°ã¤¦WPW¡¥ GE #305 PQû½Ì¡¤IVCD¡¥ ¿ÇÃÇ¡§WPW¡¥V4-6¤ÎSÇȤÏÀµ¾ï¤Ç¤¢¤ê¡¤IVCD¤ÏÈÝÄê¤Ç¤­¤ë¡¥ ¶½Ê³¤¬Kent«¤«¤é¿´¼¼¤ËÆþ¤ê¡¤µÕ¹ÔÀ­¤ËAV node¤ò°ì½ä¤¹¤ë¿´¼¼ÉÑÇï¤Ï antidromic¤È¤è¤Ð¤ì¤ë¡¥wide-complex tachycardia¤ÇVT¤È¶èÊ̤Ǥ­¤Ê¤¤¡¥ ÉÑÇï¤Ç¤¢¤ë¡¥¤Þ¤¿AF¤äAf¤È¤Î1:1Âбþ¤ÏÉÑÇ郎Áᤤ¡¥ µÕ¤ËAV node¤«¤éKent«¤Ë¸þ¤«¤¦¥ë¡¼¥×¤Ïorthodromic¤È¤è¤Ð¤ì¤ë¡¥ Àµ¾ïÅÁƳ¤Ç¤¢¤ë¤«¤énarrow-complex tachycardia¤Ç¤¢¤ê¡¤´í¸±ÅÙ¤ÏÄ㤤¡¥ AV node¤ÎÃٱ䤬Ư¤¯¤¿¤á¤Ç¤¢¤ë¡¥ÉÑÇï¤ÏÃÙ¤¤¡¥ ´§ÀÅ̮ƶ¤ÏÁÎ˹ÊÛ¤ÎÇئ¤òÁö¹Ô¤·¡¤º¸¼¼¸åÊÉÃæ³Ö¤Ë°ÌÃÖ¤¹¤ë¡¥ ¤½¤Î¤¿¤á¤Ë¡¤´§ÀÅ̮ƶĴΧ¤ÎWPWÉûÅÁƳϩ¤Ïº¸¼¼¸åÊÉÃæ³ÖÉÕ¶á¤È¹Í¤¨¤é¤ì¤ë¡¥ wpw2.png ´§ÀÅ̮ƶĴΧ¤Ë¤è¤ëWPWÇÈ·Á 2018ǯ12·î22Æü(ECG4.doc)¤è¤ê ¿´Çï¿ô 80¡¤P¼´ 118, QRS¼´ 77, T¼´ 85 wpw3.pdf
Block¤Ç¤ÎTÇÈÌܼ¡¤ËÌá¤ë¡£
concordant ¶ËÀ­¤¬°ìÃ× discordat ¶ËÀ­¤¬ÉÔ°ìÃ×(µÕž¡¤È¿Å¾) ºÇ¸å¤ÎQRS¤ÎÊý¸þ¤Ëdiscordant¤¬Àµ¾ï¤Ç¤¢¤ê¡¤concordant¤Ç¤Ïµõ·ìÊѲ½¤È¤ß¤Ê¤¹¡¥ RBBB¤ª¤è¤ÓIRBBB¤Ç¤ÏSÇȤϲ¼¸þ¤­¤À¤«¤é¾å¸þ¤­¤ÎTÇȤˤʤꡤÀµ¾ï¤È¶èÊ̤Ǥ­¤Ê¤¤¡¥ final p.86
PE(ÇÙ¹¼ºÉ)Ìܼ¡¤ËÌá¤ë¡£
ÇÙ¹¼ºÉ ¤½¤ÎPE¤Î¿´Åſ޽긫¤Ç¤Ï¡¤¤¤¤ï¤æ¤ëS1Q3¤Î±¦¼¼Éé²Ù¥Ñ¥¿¡¼¥ó¡Ê¿Þ3º¸¡Ë¤¬Í­Ì¾¤Ç¤¹¤¬¡¤ ¤ß¤«¤±¤ëÉÑÅÙ¤Ï30¡ó°Ê²¼¤Ç¤¹¡£¤·¤«¤â½Å¾ÉÅ٤ȤϤ¢¤Þ¤êÁê´Ø¤·¤Þ¤»¤ó¡£ ¼Â¤Ï¡¤¤½¤ì¤è¤ê¤â±¦Â¦¶»ÉôͶƳ¡ÊV1-3¡Ë¤ÎTÇȤÎÊѲ½¤Î¤Û¤¦¤¬Í½¸å¤ò¤è¤¯È¿±Ç¤·¤Þ¤¹¡Ê¿Þ3±¦¡Ë¡£ ¤·¤«¤·»ÄÇ°¤Ê¤¬¤é¡¤¤¤¤º¤ì¤âÉÑÈˤˤߤ«¤±¤ë½ê¸«¤Ç¤Ï¤¢¤ê¤Þ¤»¤ó¡£ McGinn-White¤Îpattern¤È¤ÏS1Q3T3¤Î¿´ÅÅ¿Þ¤ò¤¤¤¦¡¥ II¤ÈIII¤Î±¢À­TÇȤϲ¼Êɤεõ·ì½ê¸«¤ÈƱ¤¸¡¥ V1¡ÁV3¤Î±¢À­TÇȤÏËÜÍè¾å¸þ¤­ÍÛÀ­TÇȤ¬Àµ¾ï¤Ç¤¢¤ë¤Î¤Ç ÌÀ¤é¤«¤Ë°Û¾ï¤Ç¤¢¤ë¡¥ T¥Ù¥¯¥È¥ë¤¬¸åÊý¤Ë¸þ¤«¤¦½ê¸«¤È¤¤¤ï¤ì¤Æ¤¤¤ë¤¬¡¤ ±¦¼¼¿´¶Ú¤Î³ÈÄ¥¤äÈîÂç¤Ëȼ¤¦¿´ÆâË즿´¶Ú¤ÎÁá´üºÆʬ¶Ë ¤Ë¤è¤ë°Û¾ï¤È¹Í¤¨¤ë¡¥ PE¤Ç¤Ï±¦¼¼³ÈÄ¥¤¹¤ë¤¬¡¤±¦¼¼ÈîÂç¤Ë¤Ï¤Ê¤é¤Ê¤¤¡¥¤½¤Î¤¿¤áV1¤ÎRÇȤϾ®¤µ¤¤¡¥ V1¤ÎrSR'¤Ï±¦¼¼ÈîÂç¤Ç¤â¶¦Ä̤¹¤ë½ê¸«¤Ç¤¢¤ë¡¥V6¤ÎSÇȤò¸«¤Æ¡¤Éý¤¬¤»¤Þ¤±¤ì¤Ð ±¦µÓ¥Ö¥í¥Ã¥¯¤Ç¤Ï¤Ê¤¤¡¥S1¤ÎSÇȤÏÉý¤¬¶¹¤¤¡¥ BB p.76, fig7.19 ÇÙ¹¼ºÉ¡¤S1Q3T3¡¤I¤ÎrS¤Ë¤è¤ë±¦¼´Êа̡¤V1¤ÏqR¤Þ¤¿¤ÏrR'¡¤V6¤ÏRS¡¤»þ·×²óž¡¥
°Ü¹ÔÂÓÌܼ¡¤ËÌá¤ë¡£
transiton °Ü¹ÔÂÓ R/SÈ椬1¤Î¾ì½ê¡¥p.219 Àµ¾ï¤Ê¤éV3¤ÈV4¤Î´Ö¤Ë¤¢¤ë¡¥ °Ü¹ÔÂÓ¤¬ V1¤Ë¶á¤Å¤¯¤ÈÈ¿»þ·×²óž(counterclockwise rotation)¡¤ V6¤Ë¶á¤Å¤¯¤È»þ·×²óž(clockwise rotation). ¶Ëü¤Ê»þ·×²óž¤Ïecg 9-11¤Ç¸«¤é¤ì¤ë¡¥ ¸¶Íý¡§ ±¦¼¼¤Ï±¦¼Ð¤áÁ°Êý¤Ë°ÌÃÖ¤¹¤ë¡¥º¸¼¼¤Ïº¸Ë¼¤äÂçÆ°Ì®¤Ë¸ÇÄꤵ¤ì¡¤°ÜÆ°¤·¤Ë¤¯¤¤ ¾õÂ֤Ǥ¢¤ë¤¬¡¤±¦¼¼¤Ï¿´ÈîÂç¤È¶¦¤Ë±¦Â¦Êý¤Ë°ÜÆ°¤Ç¤­¤ë¡¥ ¤·¤¿¤¬¤Ã¤Æ¡¤È¿»þ·×²óž¤ÏÍưפËÍ­¤êÆÀ¤ë¡¥ °Ü¹ÔÂÓ¤¬V1¡ÁV2¤Ê¤ÉÈ¿»þ·×²óž¤¹¤ë¤ÈRÇȤ¬¹â¤¯¤Ê¤ê¡¤±¦¼¼ÈîÂ硤¸åÊɹ¼ºÉ¤ò¹Íθ¤¹¤ë¡¥ ecg 11-22¡¥ »þ·×²óž¡§ º¸¼¼ÈîÂ硤 V1¤ÎR¤¬¾®¤µ¤¯¤Æ¤âȯÀ¸¤¹¤ë±¦¼¼ÈîÂç(MS, PH, COPD, PE)¡¥ ξ¿´ÈîÂç¡¥ ALFB pectus exavatum(ϳÅͶ») ¿´Â¡¤¬¿åÊ¿°Ì¤Ë¤Ê¤ë¤ÈÈ¿»þ·×Êý¸þ²óž(good R progression, early transition)¤ò ¤ª¤³¤·¤ä¤¹¤¤¡¥V1¤Îr¤¬Â礭¤¯¤Ê¤ë¡¥ I¤ÈaVF¡¤II¤ÈaVF¤Ï»÷¤Æ¤¤¤ë¡¥ S1S2S3¤ÏÉÔÄê¼´¤Ë¤Ê¤ë¡¥ ¿´Â¡¤¬È¿»þ·×Êý¸þ²óž¤ò¤ª¤³¤»¤Ð¡¤ V1¤ÈV6¤ÎRÇȤ¬¹â¤á¤Ë¤Ç¤ë¡¥ EMS 12 Lead Prominent R Wave in Lead V1: Electrocardiographic Differential Diagnosis. Mattu, Brady, et al. Am J Emerg Med 2001;19:504-513. Right bundle branch block Left ventricular ectopy Right ventricular hypertrophy Acute right ventricular dilation Wolff-Parkinson-White syndrome Type A Posterior myocardial infarction Hypertrophic cardiomyopathy Progressive muscular dystrophy Dextrocardia Misplaced precordial leads Normal variant
´§Æ°Ì®Ìܼ¡¤ËÌá¤ë¡£
´§Æ°Ì®¤Î²ò˶¡§final p.60
´§ÀÅ̮ƶĴΧÌܼ¡¤ËÌá¤ë¡£
ÉáÄ̤ο´ÅſޤǤϣ±£²Í¶Æ³¿´ÅſޤȤ¤¤Ã¤Æ¡¢ ¿´Â¡¤ò£±£²¤ÎÊý¸þ¤«¤é¿´ÅÅ¿Þ¤òµ­Ï¿¤¹¤ë¤ó¤Ç¤¹¤¬¡Ê¿ÈÂΤËÉÕ¤±¤ëÅŶˤϣ±£°¸Ä¡Ë ¤½¤Î¤¦¤Á¤Î IIͶƳ¤ÈIIIͶƳ¤ÈaVfͶƳ¤È¤¤¤¦½ê¤Î£ÐÇÈ¡Ê¿´Ë¼¤Î¼ý½Ì¤¹¤ë¤È¤­¤ÎÇȡˤ¬ ²¼¸þ¤­¤Ë¤Ê¤Ã¤Æ¤¤¤ë¡ÊÄ̾ï¤Ï¾å¸þ¤­¡Ë¤â¤Î¤ò´§ÀÅ̮ƶĴΧ¤È¸Æ¤ó¤Ç¤¤¤Þ¤¹¡£ GE #272, PR 0.13, Axis -20¡ë¡¤ÊаÌÌ̤¬V1¤ÈV2¤Î´Ö¤Ï°Û¾ï¡¥NSTWC¡¥ ¿´ÅÅ¿ÞII,III,aVFͶƳ¤Ç¤Î±¢À­PÇȤǼ¨¤µ¤ì¤ëµÕ¹ÔÀ­PÇÈĴΧ¤Ï¸Å¤¯¤è¤ê´§ÀÅ̮ƶĴΧ¤È ¸Æ¤Ð¤ì,ÀèÅ·À­¿´¼À´µÆä˺¸¾åÂçÀÅÌ®°ä»Ä¾É,ÀÅ̮ƶ·¿¿´Ë¼Ãæ³Ö·ç»¾É, ²¼ÂçÀÅÌ®·ç»¾ÉÎã¤Ç¹âÉÑÅ٤ˤߤé¤ì¤ë¤³¤È¤¬ÃΤé¤ì¤Æ¤¤¤ë. ·Ð¸³¤·¤¿¤³¤ì¤é¼À´µ·²¤Î¤¦¤Á,´§ÀÅ̮ƶĴΧ¤òÄ褷¤¿¤Î¤Ï º¸¾åÂçÀÅÌ®°ä»Ä¹çÊ»Îã35ÎãÃæ7Îã(20.0%),ÀÅ̮ƶ·¿¿´Ë¼Ãæ³Ö·ç»¾É14ÎãÃæ4Îã(28.6%)¤Î ¹âΨ¤Ç¤¢¤Ã¤¿.²¼ÂçÀÅÌ®·ç»Îã¤Î1Îã¤Ïº¸¾åÂçÀÅÌ®¸¯»Ä¤ò¹çÊ»¤·´§ÀÅ̮ƶĴΧ¤Ç¤¢¤Ã¤¿. ÂоȤȤ·¤ÆÁª¤ó¤ÀÍñ±ßãÝ·¿¿´Ë¼Ãæ³Ö·ç»¾É173ÎãÃæ´§ÀÅ̮ƶĴΧ¤Ï5Îã(2.9%)¤Ë ¤È¤É¤Þ¤Ã¤¿.Íñ±ßãÝ·¿¿´Ë¼Ãæ³Ö·ç»¾ÉÎã¤Î½Ñ¸å¿´ÅÅ¿Þfollow upÃæP¼´¤Îº¸¼´²½¤ò 43Îã(24.9%)¤Ëǧ¤á,¤½¤Î¤¦¤Á´§ÀÅ̮ƶĴΧ¤Ø¤Î°Ü¹Ô¤¬22Îã(12.7%)¤Ë¤ß¤é¤ì¤¿. ÂçÀÅÌ®¤Ø¤Î¥¿¡¼¥Ë¥±¥Ã¥È¤ò»ÈÍѤ¹¤ë¿´Ë¼Ãæ³Ö·ç»¾É½¤Éü¤Ç¤Ï,¤³¤ì¤Ë¤è¤ëƶ·ëÀá¤Î ¾ã³²¤Ë¤è¤ê½Ñ¸å´§ÀÅ̮ƶĴΧ¤òÀ¸¤¸¤ë¤â¤Î¤È¹Í¤¨¤é¤ì¤¿. PR¤Ï 0.12Éðʾå¤Ç¤¢¤ë¡¥ ´§ÀÅ̮ƶĴΧ (coronary sinus rhythm)
ÉÔÀ°Ì®Ìܼ¡¤ËÌá¤ë¡£
irregularly irregular ÀäÂÐŪÉÔÀ°Ì®
¥ß¥é¡¼¥¤¥á¡¼¥¸Ìܼ¡¤ËÌá¤ë¡£
ST¾å¾º(STE)¤ËÂФ·¤ÆÂЦ¿´¶Ú¤ÎSTÄã²¼(STD)¤ò¼¨¤¹¡¥ TÇȤËÂФ·¤Æ¤ÏÊѲ½¤¬¤Ê¤¯¡¤µÕž¤ÏÀ¸¤¸¤Ê¤¤¡¥Ã±¤ËÀÅ»ßÅṲ̋À¤±¤ÎÊѲ½¤Ç¤¢¤ë¡¥ cf. final p.52 ¦Êɹ¼ºÉ¡§I,aVL¤ÎSTE¤ËÂФ·¤ÆII,III,aVF¤ÎSTD¡¤II¤ÎÊѲ½¤Ï¾¯¤Ê¤¤¡¥GE #104¡¥ ²¼Êɹ¼ºÉ¡§II, III, aVF¤ÎSTE -> I, aVL¤ÎSTD ±¦¼¼¹¼ºÉ¡§VR¤ÎSTE ->V1, V2¤ÎSTD¡¤¤·¤«¤·±¦¼¼¹¼ºÉ¤ÏV1,V2¤ÎSTE¤¬Í­¤êÆÀ¤ë¡¥ ±¦¼¼Êɤ϶»ÉôÁ°Ì̤ˤ¢¤ë¤¿¤á¡¥ ¸åÊɹ¼ºÉ¡§V6¡ÁV9¤ÎSTE -> V1, V2¤ÎSTD
¥¹¥È¥ì¥¤¥óTÇÈÌܼ¡¤ËÌá¤ë¡£
Æþ±¡Ãæ¤Ë¿´Åſ޽긫¤¬¥¹¥È¥ì¥¤¥ó¥Ñ¥¿¡¼¥ó¤ËÊѲ½¤·¤¿Ä¶¹âÎ𿲶ñÁ´¤Î1Îã ²¼·¦ Å°¡¤Ç÷ÅĹ̰ìϺ¡§Æþ±¡Ãæ¤Ë¿´Åſ޽긫¤¬¥¹¥È¥ì¥¤¥ó¥Ñ¥¿¡¼¥ó¤ËÊѲ½¤·¤¿Ä¶¹âÎð¿´ÉÔÁ´¤Î1Îã¡¥¿´Â¡ 43:43-48, 2011. LVH º¸¼¼ÈîÂç¤Î½ê¸«¤È¤·¤Æ¤Ïº¸¼¼¹âÅÅ°Ì¡¢QRS»þ´Ö¤Î±äĹ¡¢ÆäËVAT¡Ê¿´¼¼¶½Ê³»þ´Ö¡Ë¤¬±ä Ť¹¤ë¡¢ST-TÊѲ½¤È¤¤¤Ã¤¿¤â¤Î¤¬ÃΤé¤ì¤Æ¤¤¤ë¡£º¸¼¼¹âÅṲ̋ΤߤǤϺ¸¼¼ÈîÂç¤È¤Ï¸À ¤ï¤Ê¤¤¡£ÈîÂ礬¿Ê¤à¤È¡¢TÇȤÎʿ󲽡¢ST²¼¹ß¡¢TÇȤα¢Å¾²½¤¬Ç§¤á¤é¤ì¤ë¤è¤¦¤Ë¤Ê¤ë¡£ ¤³¤ì¤é¤ò¥¹¥È¥ì¥¤¥ó·¿ST-TÊѲ½¤È¤¤¤¦¡£¥¹¥È¥ì¥¤¥ó·¿¤Ç¤Ï¾å¤ËÆ̤ÎSTÄã²¼¤Ç¤¢¤ê¡¢ Á°È¾¤¬¤Ê¤À¤é¤«¤Ç¸åȾ¤¬µÞ·ã¤Êº¸±¦ÈóÂоÎÀ­¤Î±¢À­TÇȤȤʤ롣I, aVL, V4¡ÁV6ͶƳ¤Ë ǧ¤á¤é¤ì¤ë¤³¤È¤¬Â¿¤¤¡£Î©°Ì¿´¤Ç¤ÏI,aVL¤Ç¤Ï¤Ê¤¯II,III,aVFͶƳ¤Ë¤³¤ì¤é¤ÎÊѲ½¤¬ ǧ¤á¤é¤ì¤ë¤³¤È¤¬¤¢¤ë¡£ RVH ±¦¼¼ÈîÂç¤ÏÇÙ¹â·ì°µ¾É¤Ê¤É¤Çǧ¤á¤é¤ì¤ë½ê¸«¤Ç¤¢¤ë¡£¥¨¥³¥Î¥ß¡¼¥¯¥é¥¹¾É¸õ·²¤Ê¤É ÇÙºÉÀò¾É¤Ç¤Ï½Å¾ÉÅÙ¡¢¼£ÎÅË¡¤ò·èÄꤹ¤ë¤¦¤¨¤Ç¤É¤ÎÄøÅÙ¤ÎÇÙ¹â·ì°µ¤¬¤¢¤ë¤Î¤«¤¬ ½ÅÍפȤʤäƤ¯¤ë¤¿¤á¡¢±¦¿´ÈîÂç¤Î½ê¸«¤ÏÈó¾ï¤Ë½ÅÍפǤ¢¤ë¡£±¦¼´Êа̡¢ÇÙÀ­PÇÈ ¡ÊPÇȤι⤵¤¬25mm°Ê¾å¡Ë¡¢V1¢·V3¤ÎRÇȤÎÁý¹â¡¢VAT¤¬0.03¤«¤é0.05Éá¢V1¡ÁV3¤Î ¥¹¥È¥ì¥¤¥ó¥Ñ¥¿¡¼¥ó¡¢I, aVL, V5, V6¤Î¿¼¤¤SÇÈ¡¢ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¤È¤¤¤Ã¤¿ ½ê¸«¤òÁȤ߹ç¤ï¤»¤ÆÇÙ¹â·ì°µ¤ÎÄøÅÙ¤òͽ¬¤¹¤ë¡£ÇÙºÉÀò¾É¤Ç¤Ï¤³¤ì¤é¤Î½ê¸«¤òºÙ¤«¤¯ ʬÀϤ¹¤ë¤È80¡ó°Ê¾å¤Î¾ÉÎã¤Ç¿´Åſް۾郎»ØŦ¤Ç¤­¤ë¤È¤µ¤ì¤Æ¤¤¤ë¡£ÁÛÄê¼À´µ¤Ë¤è¤Ã¤Æ Àµ¾ï¤ÎÈϰϤ¬ÊѲ½¤¹¤ë½ÅÍפÊÎã¤Ç¤¢¤ë¡£ ¿´ÅÅ¿Þ¤ÎÆɤßÊý II, III, aVF¤Î¾®¤µ¤ÊqÇÈ¡¢±¢À­TÇȤËÃí°Õ¡¥
¾®¤µ¤ÊV6Ìܼ¡¤ËÌá¤ë¡£
V6¤ÎRÇȤ¬¾®¤µ¤¤¡¥º¸¿´¼¼¤Îµ¡Ç½Äã²¼¤Ç¤¢¤ë¡¥ BB fig. 10.19 (p.133)CLBBB¤Ç¤ÏV1-V5¤¬QS¥Ñ¥¿¡¼¥ó¡¤V6¤À¤±¤¬¾®¤µ¤¯Éý¤Î¹­¤¤RÇÈ¡¥ °ìÈ̤ËCLBBB¤Ïº¸¼¼ÅÁƳÃÙ±ä¤À¤«¤éQRS¤Î¿¶Éý¤ÏÂ礭¤¯¤Ê¤ë¡¥ GE #57 V6¤ÇQSÇÈ·Á¡¤Â¦ÊɸåÊɹ¼ºÉ¡¥aVR¤¬qRÇÈ·Á¡¥ GE #73 ¼´-60 V1-V5¤Þ¤ÇrS¤Ç»÷¤¿ÇÈ·Á¡¤V6¤ÏRS¤À¤¬S¤ÎÊý¤¬Â礭¤¤¡¥ LAFB, QRSÉý¤¬0.14¤À¤«¤é,¤Þ¤¿¥Î¥Ã¥Á¤¬¤¢¤ë¤¿¤áIVCD¡¥ GE #121 II, aVF¤¬¡Ý¤À¤«¤é¼´¤Ï-30¡ë°Ê²¼¡¤V1¤¬PVC¤Î¤è¤¦¤Ë¸«¤¨¤ë¤¬µðÂç¤ÊrsR' ¤Ç¤¢¤ë¡¥V1-V3¤Þ¤ÇrsR'¤ÇȿžTÇÈ¡¤V4-V6¤ÏrSÇȤÇÍÛÀ­TÇÈ¡¥ ¿ÇÃÇ¡§LAFB+CRBBB¡¥ËÜÍèRBBB¤Ï±¦¼¼ÈîÂç¤Î¿ÇÃǤϽÐÍè¤Ê¤¤¤¬¡¤ V1¤Î°Û¾ï¤Ê¹â¤µ¤ÎR'¤ÈV6¤ÎSÇÈ¡¤¤½¤·¤ÆȿžTÇȤÏRVH¤òµ¿¤ï¤»¤ë¡¥ Ä̾ï¤ÎCRBBB¤Ç¤ÏV6¤ÏRÇȤÈÉý¹­¤ÎSÇȤǤ¢¤ë¤¬¡¤RVH¤Ç¤ÏRÇȤ¬¾®¤µ¤¯¡¤ SÇȤϱԤ¯¿¼¤¤¡¥ GE #196 ¼´90°Ê¾å¡¤ÇÙÀ­PÇÈ¡¤V1¤ÏrsR'¤Ç¤¢¤ë¤¬¡¤rs¤ÏÈó¾ï¤Ë¾®¤µ¤¤¡¥R'¤Ï¥·¥ã¡¼¥×¤Ç Ä̾ï¤Î±¦µÓ¥Ö¥í¥Ã¥¯¤È°Û¤Ê¤ë¡¥V2¡ÁV6¤Þ¤Ç¤Ï¶¯¤¤Éý¤Î¶¹¤¤SÇÈ¡¥±¦µÓ¥Ö¥í¥Ã¥¯ ¤Ç¤¢¤ì¤ÐS¤ÏÉý¤¬¹­¤¤¤«¤é¡¤¤³¤ÎÅÀ¤«¤é¸«¤Æ¤âRBBB¤È¤Ï°Û¤Ê¤ë¡¥V1¤Ï ±¢À­TÇȤǡ¤V2¤Ïʿó¡¤V3-V6¤ÏÄ̾ï¤ÎTÇÈ¡¥RÇȤÏV3¤¬ºÇ¤â¹â¤¯¡¤ V6¤Ë¹Ô¤¯¤Ë¤·¤¿¤¬¤Ã¤ÆÇȹâ¤Ï¾®¤µ¤¯¤Ê¤ë¡¥ÇÙÀ­PÇȤȱ¦¼¼ÈîÂç¡¥ GE #249 I,aVL¤ËQÇÈSTE¡¤V1¡ÁV6¤Þ¤ÇQS¡¤STE¡¤ST¤Ï¾å¸þ¤­±ú¤Ç¤¢¤ë¡¥Á°ÊɦÊɹ¼ºÉ¤Î ·ìÀò½üµî¸å¡¥V6¤Ê¤ÉËÜÍèRÇȤǤ¢¤ëÉô°Ì¤¬¹¼ºÉ¤Ë¤è¤êQS¤Ë¤Ê¤ë¤È¡¤ ÅṲ̋⸺¼å¤µ¤ì¡¤µæ¶Ë¤ÎPRP¤Ë¤Ê¤ë¡¥ ecg 9-16 Á´¤Æ¤Î¶»ÉôͶƳ¤ÇQS¥Ñ¥¿¡¼¥ó ecg 16-7 ¹âK·ìÞù¤Ç¶»ÉôͶƳ¤¬rS¥Ñ¥¿¡¼¥ó¤Ë¤Ê¤ëIVCD¡¥V6¤âÉý¹­rS¥Ñ¥¿¡¼¥ó
V6¤ÎQS¥Ñ¥¿¡¼¥óÌܼ¡¤ËÌá¤ë¡£
#57 ¦ÊɸåÊɹ¼ºÉ #249 Á°ÊÉÃæ³Ö¦Êɹ¼ºÉ #293 ²¼ÊɦÊɹ¼ºÉ #294 ¿´¼¼¥Ú¡¼¥·¥ó¥°
¾®¤µ¤ÊV1Ìܼ¡¤ËÌá¤ë¡£
V1¤Î¿¶Éý¤¬¾®¤µ¤¤¾ì¹ç¤ÏÇÙµ¤¼ð¤ò¹Í¤¨¤ë¡¥ BB p.46, fig4.34 I¤ÇrS, ±¦¼´ÊÑ°Ì, RVH, COPD¡¤ÇÙÀ­PÇÈ¡¤»þ·×²óž¡¥V1¤ÏQS¡¤V6¤ÏrS¡¥ BB p.63, fig7.4 RVH, COPD¡¤ÇÙÀ­PÇÈ¡¤»þ·×²óž¡¤V1¤ÏQS¡¤V6¤ÏrS¡¥ BB p.75, fig7.17 RVH, COPD¡¤ÇÙÀ­PÇÈ¡¤»þ·×²óž¡¤V1¤ÏQS¡¤V6¤ÏrS¤ÇÄ㿶Éý¡¥I¤Ï¿åÊ¿¡¥ BB p.76, fig7.19 ÇÙ¹¼ºÉ¡¤S1Q3T3¡¤I¤ÎrS¤Ë¤è¤ë±¦¼´Êа̡¤V1¤ÏqR¤Þ¤¿¤ÏrR'¡¤V6¤ÏRS¡¤»þ·×²óž¡¥ BB p.87, fig8.17 ²¼Êɹ¼ºÉ¡¤V1¤ÏrS¡¤V3¤ÎrS¤ÏÉԻ׵ġ¤ÅŶ˴ְ㤤¤Î²ÄǽÀ­¡¥ BB p.117, fig9.11 LPFB º¸¼¼¸å»Þ¥Ö¥í¥Ã¥¯¡¥V1¤ÏrS¤Ç¤¢¤ë¤¬¡¤RÇȤÎÁý¹â¤ÏÀµ¾ï¡¥ BB p.118, fig9.13 RVH¡¤ÇÙÀ­PÇÈ¡¤¼´90¡ë°Ê¾å¡¤V1¤ÏQS¡¤V2¡ÁV6¤Þ¤ÇrSÇÈ¡¥ BB p.118, fig9.14 ¹â°Ì¦Êɹ¼ºÉ¡¤v1¤ÏqrÇÈ¡¤V2¡ÁV4¤Þ¤ÇQSÇÈ¡¤¡¥ BB p.126, fig10.12 Idioventricular Rhythm. BB p.142, fig11.5A Ventricular escape. BB p.143, fig11.6A Ventricular escape. GE #25 Axis -30, rS¤ÇÀµ¾ïÇÈ·Á¡¥-30¤Ê¤éLAFB¤È¤»¤º¤ËÀµ¾ï¤Ë¤¹¤ë¡¥ GE #186 ´Ö·çŪWPW Type B¤À¤«¤éº¸µÓ¥Ö¥í¥Ã¥¯·¿¡¥intermittent preexcitation.
ÊѹÔÅÁƳÌܼ¡¤ËÌá¤ë¡£
¿´¼¼ÆâÊѹÔÅÁƳ¡Òaberrant intraventricular conduction¡Ó a) ¾å¼¼Éô¤«¤é¤Î¥¤¥ó¥Ñ¥ë¥¹¡ÊÅŵ¤Åª»É·ã¡Ë¤¬¿´¼¼¤ËÅþ㤷¤¿»þÅÀ¤Ç¡¢¿´¼¼Æâ»É·ãÅÁƳ·Ï¤¬Àè ¹Ô¤¹¤ë¿´¼þ´ü¤Î¶½Ê³¤«¤é³Ð¤á¤­¤é¤ºÉÔ±þ´ü¤Ë¤¢¤ë¾ì¹ç¡¢¥¤¥ó¥Ñ¥ë¥¹¤Î¿´¼¼ÆâÅÁÇŤ¬°Û¾ï¤Ë Ãٱ䤹¤ë¤¿¤áÊѹԤ¹¤ë¤³¤È¤ò¿´¼¼ÆâÊѹÔÅÁƳ¤È¤¤¤¦¡£ÊѹÔÅÁƳ¤Ï±¦µÓ¥Ö¥í¥Ã¥¯·¿¡¤ º¸µÓ¥Ö¥í¥Ã¥¯·¿¡¤¤Þ¤¿¤Ïº¸µÓ¤Îʬ»Þ¥Ö¥í¥Ã¥¯·¿¤Ç¤¢¤ë¡¥ b) °ìÈ̤˿´¶Ú¤ÎÉÔ±þ´ü¤ÏÀè¹Ô¤¹¤ë¿´¼þ´ü¤ÎŤµ¤ËÈæÎ㤷¡¢Àè¹Ô¿´¼þ´ü¤¬Ã»¤¤¤È¤­¤ÏÉÔ±þ´ü¤¬ û¤¯¡¢Ä¹¤¤¤È¤­¤ÏÉÔ±þ´ü¤âŤ¤¡£¿´¼¼Æâ»É·ãÅÁƳ·Ï¤ÎÃæ¤Ç±¦µÓ¤ÎÉÔ±þ´ü¤¬ºÇ¤âŤ¯¡¢V1Ͷ Ƴ¤ÇrSR'·¿¤Î±¦µÓ¥Ö¥í¥Ã¥¯·¿ÇÈ·Á¤È¤Ê¤ë¡£ c) ¿´¼¼ÆâÊѹÔÅÁƳ¤Ë¤è¤ê¡¢¿´ÅÅ¿Þ¾åQRSÇȤ¬¿´¼¼´ü³°¼ý½Ì¤ÎÇÈ·Á¤Ë»÷¤Æ¤¤¤ë¤¿¤á¿´¼¼´ü ³°¼ý½Ì¤ÈȽÃǤµ¤ì¤¿¤ê¡¢¾å¼¼À­¤ÎÉÑÇï»þ¤ËQRSÇȤÎÉý¤¬¹­¤¤¤¿¤á¤Ë¿´¼¼ÉÑÇï¤È´Ö°ã¤¨¤é¤ì ¤ë¤³¤È¤¬¤¢¤ë¡£ ʸ¾Ïa)¤Î¡ÖÀè¹Ô¤¹¤ë¿´¼þ´ü¤Î¶½Ê³¤«¤é³Ð¤á¤­¤é¤ºÉÔ±þ´ü¤Ë¤¢¤ë¾ì¹ç¡×¤È¤Ï¡¤ ¿´¶Ú¤¬ºÆʬ¶Ë¤¹¤ë¤Þ¤Ç¤Î»þ´Ö¤ò¼¨¤·¡¤Phase 3 Aberration, ¤¹¤Ê¤ï¤ÁTÇȤÎÅÓÃæ¤Ç¼¡¤ÎQRS¤¬È¯À¸¤¹¤ë¤³¤È¤ò°ÕÌ£¤¹¤ë¡¥ ¡ú °ã¤¤¡§ ¡û ventricular ectopy¡¡°Û½êÀ­¿´¼¼¶½Ê³¡¢¿´¼¼´ü³°¼ý½Ì Éý¤Î¹­¤¤QRS¤ÇTÇȤϵÕž¤¹¤ë¡¥¹â¿¶Éý¡¥Ä´Î§¤È´Ø·¸¤Ê¤¯È¯À¸¡¥ ¡û aberrancy ÊѹÔÅÁƳ¡¥ Phase3¤Þ¤¿¤Ï4¤ÇȯÀ¸¤¹¤ë±¦µÓ¥Ö¥í¥Ã¥¯¤Þ¤¿¤Ïº¸µÓ¥Ö¥í¥Ã¥¯·¿¤ÎQRS¤ÇVT¤äSVT¤Ê¤É¤Î ÉÑÌ®¤Ë¤Ê¤ë¤³¤È¤¬Â¿¤¤¡¥ 2:1¤ÎAFĴΧ¤«¤éPhase 3¤Îº¸µÓ¥Ö¥í¥Ã¥¯·¿¤ÎÊѹÔÅÁƳ¤¬3Ϣȯ³¤­¡¤¤½¤Î¸å1:1¤ÎAF¤ÎPSVT¤Ë¤Ê¤Ã¤Æ¤¤¤ë¡¥ 3Ϣȯ¤ÎQRSÉý¤¬¶¹¤¯¤Ê¤ëÍýͳ¤Ïº¸µÓ¥Ö¥í¥Ã¥¯¤¬¤½¤Î´Ö¤Ë²þÁ±¤µ¤ì¤¿¤¿¤á¤Ç¤¢¤ë¡¥ aberrant.pdf abe1.pdf abe2.pdf ¡ú retrograde concealed conduction µÕ¹ÔÀ­ÉÔ¸²À­ÅÁƳ µÓ¥Ö¥í¥Ã¥¯¤Î¶½Ê³ÅÁƳ¤¬Â¾Â¦¤ËÅÁÇŤ¹¤ë¤È¤½¤ì¤Ï°ìÈÌ¿´¶Ú¤ÎÅÁƳ¤Ë¤Ê¤ë¡¥ ¤½¤Î¿´¶Ú¶½Ê³¤¬µÕ¹ÔÀ­¤Ë»É·ãÅÁƳ·Ï¤ò¶½Ê³¤µ¤»¤ë¤¿¤á¡¤ºÆ¤ÓµÓ¥Ö¥í¥Ã¥¯¤¬ »ý³¤¹¤ë¤³¤È¤ò°ÕÌ£¤¹¤ë¡¥SVT¤Î°ìÈÌŪ¤Ê½ê¸«¤Ç¤¢¤ë¡¥ ¡ú IKur¤ÈIKs¤Ïæʬ¶Ë½ªÎ»¸å¤¹¤°¤µ¤ÞK¥Á¥ã¥Í¥ë¤òÊĤ¸¤ë¤¬¡¤ IKr¤ÏK¥Á¥ã¥Í¥ë¤Î³«¸ý¾õÂÖ¤¬¤·¤Ð¤é¤¯»ý³¤¹¤ë¡¥ ÄãK·ì¾É¤Ë¤Ê¤ë¤È¡¤¤³¤Î»ý³³«¸ý¸ú²Ì¤¬¸º¼å¤¹¤ë¡¥¤·¤¿¤¬¤Ã¤ÆLQT¤ÇÄãK·ì¾É¤Ë¤Ï Ãí°Õ¤¬É¬ÍפǤ¢¤ë¡¥ cf. Channel.pdf. ¡ú concealed conduction ÉÔ¸²À­ÅÁƳ PVC¤Î¸å¡¤¼¡¤ÎƶĴΧ¤¬·ç»¤¹¤ë¾ì¹ç¡¤PVC¤¬µÕ¹ÔÀ­¤ËAV Node¤ò»É·ã¤·¤Æ ÉÔ±þ´ü¤Ë¤Ê¤ë¤¿¤á¤ËÁêĴΧ¤ÎÅÁƳ¤¬ÍÞÀ©¤µ¤ì¤ë¤¿¤á¤Ç¤¢¤ë¡¥
VT¤ÈSVTÌܼ¡¤ËÌá¤ë¡£
·ì°µ¤Ê¤É½Û´ÄÆ°ÂÖ¤¬°ÂÄꤷ¤¿¾õÂ֤ǤÎVT¤ò´Ö°ã¤Ã¤ÆSVT¤ÈȽÃǤ·¡¤ SVT¤Î¹³ÉÔÀ°Ì®ÌôºÞ¤òÅêÍ¿¤¹¤ë¤È´Ö¤¸¤ã¤Î¾õÂÖ¤òÈó¾ï¤Ë°­²½¤µ¤»¤ë¾ì¹ç¤¬Â¿¤¤¡¥ ¤½¤Î¤¿¤á¤ËVT¤ÈSVT¤È¤Î´ÕÊ̤ϽÅÍפǤ¢¤ë¡¥ VT¤ÈSVT¤Î´ÕÊÌ¡§ Welens p.47 Fig 3-7¤Èp.49 Fig 3-9 Wide QRS Tachycardia¤Î´ÕÊ̤ϡ¤²¼¿Þ¤ò»²¹Í¤Ë¤¹¤ë¡¥ SVT¤Î¾ì¹ç¤Ï±¦µÓ¥Ö¥í¥Ã¥¯·¿¡¤º¸µÓ¥Ö¥í¥Ã¥¯·¿¤¬¤¢¤ë¡¥ CRBBB·¿¤Ç¤ÏV1¤ÏrsR'·¿¤Ç¡¤V6¤ÏRS·¿¤Ç¤¢¤ê¡¤V6¤ËqÇȤ¬¸«¤¨¤ë¤³¤È¤â¤¢¤ë¡¥ CLBBB·¿¤Ç¤ÏV1¤ÏÉý¤Î¶¹¤¤rS·¿¡¤V6¤ÏqÇȤΤʤ¤RÇȤǤ¢¤ë¡¥ ËܼÁŪ¤ËPurkinjeÅÁƳ¤ò¹Ô¤¦¤Î¤Ç¡¤ÇÈ·Á¤ÏµÞ½Ô¤Ç¤¢¤ë¡¥ ±¦µÓ¥Ö¥í¥Ã¥¯·¿¤ÎVT¤ÏRÇȤβ¼¹ÔÉô¤Ë¥Î¥Ã¥Á¤¬¤¢¤ë¤³¤È¤â¤¢¤ë¡¥ RsÇÈ¡¤qRÇȤˤʤ뤳¤È¤â¤¢¤ë¡¥V1¤¬RÇȤˤʤëÉÑÌ®¤ÏrsR'¤Ç¤Ê¤±¤ì¤ÐVT¤Ç¤¢¤ë¡¥ V6¤Ïɬ¤ºrSÇȤǤ¢¤ë¡¥SVT¤Ç¤ÏRSÇȤǤ¢¤ë¡¥ º¸µÓ¥Ö¥í¥Ã¥¯·¿¤ÎVT¤ÏÉý¤Î¹­¤¤rÇȤȥΥåÁ¤Þ¤¿¤Ï¥¹¥é¡¼¤òȼ¤¦V1¤Ç¤¢¤ê¡¤ V6¤âÉý¤Î¹­¤¤qÇȤǤ¢¤ë¡¥V6¤ÎRÇȤÏĺÅÀ¤¬1¤Ä¤Ç¤¢¤ë¡¥ ËܼÁŪ¤ËºÙ˦´ÖÅÁƳ¤ò¹Ô¤¦¤Î¤Ç¡¤ÇÈ·Á¤ÏÆßËá¤Ç¤¢¤ë¡¥ V1¤«¤éV6¤Þ¤ÇÁ´¤ÆS·¿¤ÏVT¤Ç¤¢¤ë¡¥Wellens: p.60 fig3-17 ¿Þ7¤Ç¤ÏB¤ËÁêÅö¤¹¤ë¡¥ V1¤«¤éV6¤Þ¤ÇÁ´¤ÆR·¿¤Ïº¸¼¼¿´´ðÉôµ¯¸¶¤Ç¤¢¤ê¡¤Ä̾ﺸ¼¼¸åÊÉÉûÅÁƳϩµ¯¸¶¤Ë¤Ê¤ë¡¥ ¥Ç¥ë¥¿ÇȤ¬È¼¤¦¤È³Î¤«¡¥¿´Ë¼ÁÆÆ°¡¤¿´Ë¼ºÙÆ°¡¤¿´Ë¼ÉÑÇï¤Ç¤¢¤Ã¤Æ¤â¤è¤¯¡¤ AVN¤òµÕ¹ÔÀ­¤ËÅÁƳ¤¹¤ë¤Èantidoromic circus movement È¿Êý¸þÀ­Àû²ó±¿Æ°¤È¤Ê¤ë¡¥ Wellens: p.61 fig3-18 orthodoromic conduction ÀµÊý¸þÀ­ÅÁƳ antidoromic conduction È¿Êý¸þÀ­ÅÁƳ circus movement Àû²ó±¿Æ° antidoromic circus movement È¿Êý¸þÀ­Àû²ó±¿Æ° Iipes & Jelife Cardiac Electrophysiology Frim Cell to Bedside Figure 80-6 Figure 80-4
AVNRTÌܼ¡¤ËÌá¤ë¡£
AVNRT atrioventicular nodal reentrant tachycardia ˼¼¼·ëÀá¥ê¥¨¥ó¥È¥ê¡¼ÉÑÇï Ä̾﷿(Slow-Fast·¿) ÈóÄ̾﷿(Fast-Slow·¿¡¢Slow-Slow·¿, ¿½ÅÅÁƳϩ) Slow pathway ÃÙÅÁƳϩ Fast pathway ®ÅÁƳϩ Over View AVNRT-²¹¸ÎÃο·- fast-slow AVNRT¤Î1Îã Åŵ¤À¸Íý³ØŪ½ê¸«¤«¤é¤ß¤¿AVNRT¤Î¿ÍÍÀ­ Lifeint hefastlane.com-AVNRT
AIVRÌܼ¡¤ËÌá¤ë¡£
Accelerated Idioventricular Rhythm Â¥¿Ê·¿¿´¼¼¸ÇͭĴΧ BB p.157, fig12.26 AIVR¡¥ I, aVR, aVL¤ÏQS·¿¤Ç¤½¤Î¾¤ÏÁ´¤ÆÉý¤Î¹­¤¤RÇÈ¡¥CRBBB·¿¤Ç¤¢¤ë¤¬¡¤ º¸¼¼´ðÉô¤Î¸¶È¯¤Î´ü³°¼ý½Ì¤ÎϢ³ÇÈ·Á¤Ç¤¢¤ê¡¤º¸¼¼¤Î¤ß¤Îñ°ì¿´Â¡¤ÎÍͤ˸«¤¨¤ë¡¥ (V6¤Ç¤ÎSÇȤϤʤ¤) ±¦µÓ¥Ö¥í¥Ã¥¯·¿¤ÎPurkinjeºÙ˦¤Î¼«Æ°Ä´Î§¤Ç¿´Çï¿ô¤¬70ÄøÅÙ¡¥ BB p.157, fig12.27 AIVR+µÕ¹ÔÀ­PÇÈ¡¥ ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤ËµÕ¹ÔÀ­PÇÈ¡¥
¿´Â¡²ò˶Ìܼ¡¤ËÌá¤ë¡£
IMG_20180724_0002.png IMG_20180724_0004.png IMG_20180724_0006.png
Luna¤Î¹Í¤¨ÊýÌܼ¡¤ËÌá¤ë¡£
aa1.gif B¤ò¸«¤ë¤È¡¤¿´ÆâË즳èÆ°ÅṲ̋«¤é¿´³°Ë즳èÆ°ÅṲ̋ò¤Ò¤¤¤Æ¤¤¤ë¡¥ RÇȤÎSTD¤ÏÀâÌÀ¤Ç¤­¤Æ¤¤¤ë¤¬¡¤TÇȤϾå¸þ¤­¤Ë¤Ï¤Ê¤é¤Ê¤¤¡¥ 0.2, CRBBB+LPFB+Á°ÊÉÃæ³ÖMI¡¥ ¿ÇÃÇ¡§peri-infarction block. #343¤ÈƱ¤¸ÇÈ·Á¡¥
GEÌܼ¡¤ËÌá¤ë¡£
GE #1 IRBBB, V2-3¤ÎTÇȤ«¤éRVH¤ÏÈÝÄê¤Ç¤­¤Ê¤¤¡¥ GE #2 LAFB+IRBBB, LAFB¤Ï¼´-70¤Ç¤ï¤«¤ë¡¥IRBBB¤ÏV1¤ÎrSR'¤ÈV6¤ÎSÇȤǤ狼¤ë¡¥ aVR¤ÎQR¤¬Â礭¤¤¡¥LAFB¤ÏPRR¤Ë¤Ê¤ë¡¥ GE #3 long QT¤ÈLAA¡¤TÇȤÎΩ¤Á²¼¤¬¤ê¤¬¤ï¤ë¤¤¡¥¥Ç¥â¤Ë»ÈÍѤǤ­¤ë¡¥ GE #4 1¡ëAV¥Ö¥í¥Ã¥¯¡¤LAFB¡¤I¤ÈaVL¤ÎȿžÂоÝTÇÈ¡¥V5-6¤ÎTÇȤÏÀµ¾ï¤Ç¤Ï¤Ê¤¤¡¥ V2-3¤ÏSTE¡¤¾å¸þ¤­ST¥»¥°¥á¥ó¥È¤ò¿åÊ¿¤Ë¸«¤ë¤ÈµÕžTÇȤˤʤ롥 Á°ÊÉÃæ³Ö¤ÎÆâËì²¼¹¼ºÉ¤Î²ÄǽÀ­¤¬¤¢¤ë¡¥cf GE #283. GE #5 I,II¤ÎSTD¡¤Tȿž¡¤III¡¤aVF¤ÎȿžTÇÈ¡¥V1-2¤ÎQS¹âÅÅ°Ì¡¥PRPV4-6¤ÎȿžTÇÈ¡¥LVH¡¥ ¿ÇÃÇ¡§AF¡¤Á°ÊÉMI¡¤digitalis effect GE #6 ¿´Çï30¡¤3¡ëA-V ¥Ö¥í¥Ã¥¯¡¤¿´¼¼Ê佼ĴΧ¡¥V1¤ÏqR, V6¤ÏrS¤ÇÉý¤¬¹­¤¤¡¥ IVCD¤È»÷¤Æ¤¤¤ë¡¥TÇȤÏȿž¤·¤Æ¤¤¤ë¡¥¿´¼¼´ü³°¼ý½Ì¤ÈƱ¤¸¡¥ GE #7 *Á°ÊÉÃæ³Ö¦Êɹ¼ºÉAMI¡¤²¼ÊɤÏÈ¿±þÀ­¤ËSTE¡¥°Û¾ïQÇÈ¡¥ GE #8 *I, aVL¤Î°Û¾ïQÇÈ¡¤STE¡¥II, III, aVF¤ÎSTD¡¥V2-6¤Î°Û¾ïQÇÈ¡¤STE¡¥Á°ÊɦÊɹâ°Ì¦ÊɤÎAMI¡¥ ¿ÇÃÇ¡§·ìÀò½üµî¸å4h¡¥cf. #39¤È¤¢¤ë¤¬#7¤Î´Ö°ã¤¤¡¥#7¤Ï·ã¤·¤¤STÊѲ½¡¥ GE #9 AVNRT, µÕ¹ÔÀ­PÇȤÏT¤Î¾å¸þÉôʬ¤Ë¤¢¤ë¡¥ ¿ÇÃÇ¡§¿´Çï¿ô180¤ÎÉÑÌ®¡¤AF¤Ç¤¢¤ì¤Ð°ìÈÌŪ¤Ë300¤Ç¤¢¤ë¤«¤é1/2¤À¤È150¤Ë¤Ê¤ë¡¥ T¤Î¾å¸þÉôʬ¤Ïupstroke of the T wave in the precordial leads. GE #10 I, aVL¤ÎȿžTÇÈ¡¥V5-6¤Î¿åʿȿžTÇÈ¡¥ ¿ÇÃÇ¡§1¡ëAV¥Ö¥í¥Ã¥¯¡¥STÊѲ½¤Ï¶¯¤¯¤Ê¤¯non-specific ST-T changes.P-R´Ö³Ö¤Ï6mm. GE #11 ¿´Ë¼¿´¼¼¥Ú¡¼¥·¥ó¥°¡¥ GE #12 *CRBBB, LAFB, 2:1¤ÎAF, LVH ¿ÇÃÇ¡§¿´Çï90¤ÎNSR¡¤TÇȤΥΥåÁ¤ÏCRBBB¤Î±¦¼¼¶½Ê³¤Ç¤¢¤ë¡¥aVL¤ÎQÇȤϹ¼ºÉ¤Î°Û¾ïQÇȤǤ¢¤ë¡¥ GE #13 AFÉÑÌ®¡¤¸Å¤¤²¼Êɹ¼ºÉ¡¥¶»Éô¤ÎSTD¡¥ ¿ÇÃÇ¡§AF¡¤LVH¡¤LVH¤ÈÉÑÌ®¤Ë¤è¤ë¿¼¤¤STD¡¥ GE #14 SNR, CRBBB. ¿ÇÃÇ¡§CRBBB¡¤Á°ÊɤȲ¼ÊɤÎSTE¤«¤é¹¼ºÉÇÈ·Á¤Ç¤¢¤ë¡¥ the ST's are upwardly convex and T inversion and ST elevation. GE #15 CLBBB¤ÈÉÑÌ®¡¥NSR¡¥ ¿ÇÃÇ¡§I¡¤aVL¤ÎSTD¤è¤êLVH¡¥V6¤ÎSTD¤¢¤ê¡¥ GE #16 WPW, V1¡ÁV6¤Þ¤Ç¤¹¤Ù¤Æ¦¤RÇÈ¡¤V1¤òRBBB¤È¹Í¤¨¤ë¤ÈV6¤ËSÇȤ¬¤Ê¤¤¤Î¤Ç ÈÝÄê¤Ç¤­¤ë¡¥ST¤Ï¿åÊ¿¤â¤·¤¯¤Ï²¼¹ß¤ÇÍÛÀ­TÇÈ¡¥µõ·ì¡¥ GE #17 QRS 0.13, CRBBB, PÇȤ¬¤Ê¤¯Nodal, QT¤¬Ä¹¤¯¡¤V6¤ò¤ß¤ì¤ÐTÇȽªÎ»¤¬Ä¹¤¤¡¥ LQT¡¥TÇȤÏconcodal. SÇȤ¬Â礭¤¤¤Ë¤â´Ø¤ï¤é¤º2ÁêÀ­¤Ç¤Ï¤Ê¤¤¡¥ GE #18 V1-4¤ÎQSÇȤÈSTE¡¤Á°ÊÉÃæ³ÖAMI¡¥ ¿ÇÃÇ¡§1¥ö·î°ÊÆâ¤ÎMI¤Ç»ý³¤¹¤ëST¾å¾º¤Ï¿´¼¼áî¤ò»×¤ï¤»¤ë¡¥ GE #19 II,III,aVL¤ÏÀµ¾ï¡¤V1¤ÏQ¡¤V2¤Ïº¯À×ÄøÅÙ¤ÎR, V1¡ÁV4¤Þ¤Ç¿¼¤¤ÂоÎÀ­T¡¥ Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ GE #20 I, aVL¹âÅÅ°Ì¥¹¥È¥ì¥¤¥óTÇÈ¡¤º¸¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #21 Àµ¾ï¡£ GE #22 LAH, II,III,aVF¤ÎST¿åÊ¿¡¤V4¡ÁV6¤ÎST¿åÊ¿¡¤µõ·ì¡¥ ¿ÇÃÇ¡§IVCD¡¥V1¤ÈV2¤ÎQRS¤Ë¥Î¥Ã¥Á¤¬¤½¤ó¤¶¤¤¤¹¤ë¤¿¤á¤ËIVCD¤È¤Ê¤ë¡¥ GE #23 NSTWC GE #24 II,III,aVF¤Î°Û¾ïQÇÈ¡¤ST²¼¹ß¡¤¸Å¤¤²¼Êɹ¼ºÉ¡¥ GE #25 LAH,È¿»þ·×²óž¡¤¾®¤µ¤ÊV1¡¥ -30¡ë¤ÏÀµ¾ï¤Ç¤â¤¢¤ë¤«¤é·Ú¡¹¤Ë¿ÇÃǤ¹¤Ù¤­¤Ç¤Ê¤¤¡¥ GE #26 I¤¬21mm, aVL¤â´Þ¤á¤Æ¥¹¥È¥ì¥¤¥ó¡¤¶¯¤¤»þ·×²óž¡¤UÇȤò´Þ¤á¤ÆLQT¡¥ º¸¼¼ÈîÂç¡¥²¼Êɹ¼ºÉ¤Î²ÄǽÀ­¡¥Á°ÊÉÃæ³Ö¹¼ºÉ¤Ç¤Ï¤Ê¤¤¡¥ III,aVF¤ÎQS¤ÏT¤Ï¾å¸þ¤­¤Ç¥¹¥È¥ì¥¤¥ó¤È¹Í¤¨¤ë¡¥II¤ÏRSÇȤÇQÇȤ¬¤Ê¤¤¡¥ ¤½¤Î¤¿¤á²¼Êɹ¼ºÉ¤È¿ÇÃǤǤ­¤Ê¤¤¡¥ GE #27 II,III,aVF¤Î¾®¤µ¤ÊQÇÈ¡¤III¤ÈaVF¤Ï²¼¹ßST¡¥V2,V3,V4¤Î¹â¤¤TÇÈ¡¥ ¹âK·ì¾É¤Ç¤Ï¤Ê¤¯Benign Early Repolarisation(BER)¡¥ GE #28 Nodal, »Í»è¥Õ¥é¥Ã¥È¡¤V1,V2¤ÎR/S¤Ï¤Ü¤Ü1¡¥V2¤ÎRS¤¬ºÇ¤âÂ礭¤¯PRP¤Ç¤¢¤ë¡¥ ±¦¼¼ÈîÂç¤Ë¤·¤Æ¤ÏV1¤ÎT¤¬È¿Å¾¤·¤Æ¤¤¤Ê¤¤¡¥°ì±þ±¦¼¼ÈîÂç¡¥ V6¤ÎÂ礭¤ÊQ¤¬µ¤¤Ë¤Ê¤ë¡¥ ¿ÇÃÇ¡§1¡ëAV block, PQ 0.24, ²¼Êɹ¼ºÉ¡¥Axis -30. LAH¤Î¾ì¹çII,III,aVF¤ËrÇȤ¬É¬ÍפÀ¤¬¡¤¤½¤ì¤¬Ìµ¤¤¤«¤é°Û¾ïQÇȤǤ¢¤ë¡¥ LAH¤Î¥Æ¥­¥¹¥È¤òÆɤà¤È¡¤I¤ÏqR¤â¤·¤¯¤ÏRÇÈ¡¤III¤ÏrSÇȤǤ¢¤ë¡¥ ¤È¤³¤í¤¬II¤ÏQr¤Ç¤½¤ÎrÇȤθå¤ËID¤¬Â¸ºß¤¹¤ë¡¥¤³¤ì¤Ï±¦¼¼¤«º¸¼¼Â¦ÊɤΠ¶½Ê³ÇÈ·Á¤Ç¤¢¤ë¡¥ V1¤Î¹â¤¤RÇȤϸåÊɹ¼ºÉ¤Î±Æ¶Á¤È¹Í¤¨¤ì¤ÐǼÆÀ¤Ç¤­¤ë¡¥¤½¤ÎÍýͳ¤Ï V5,V6¤ÎQÇȤ¬Â¸ºß¤¹¤ë¤«¤éÅöÁ³¸åÊɹ¼ºÉ¤òȼ¤Ã¤Æ¤¤¤ë¤È¹Í¤¨¤ë¤Ù¤­¡¥ II,III,aVF¤Î¹¼ºÉ¤Î±äŤǤ¢¤ë¡¥ GE #29 V3-5¤ÎNSST-TWC. ¿ÇÃÇ¡§V3-6¤Þ¤Çsagging TÇÈ¡¥ GE #30 CRBBB+LVH¡¥º¸Ë¼ÈîÂ硤LQT¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #31 I,aVL¤ÏTȿž¡¤I,III,aVF¤ÏÀµ¾ï¡¤V1¡ÁV3QÇȤÇTÇÈȿž¡¤V4¡ÁV6¿åÊ¿ST¤ÇTȿž¡¥ V2¤ÏST¾å¾º¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¡¥¿ÇÃǤˤÏÃæ³Ö¹¼ºÉ¤Ï¤Ê¤¤¡¥ GE #32 QRSÉý¹­¤¤¡¤Á´¤Æ¤ÎͶƳ¤ÇR¤ÈT¤¬È¿Å¾¡¤º¸µÓ¥Ö¥í¥Ã¥¯·¿¤Î¿´¼¼Ê佼ĴΧ¡¥ ¿ÇÃǤÏAF¡¤IVCD¡¤LVH¡¥¤·¤«¤·V6¤ËSÇȤϤʤ¯¡¤ILBBB¤Ç¤¢¤ë¡¥ GE #33 PR0.28ÉäǤ¢¤ë¤¬WPW¡¥V1¤ÏRÇÈ¡¤¼´¤Ï¡Ý¤À¤«¤é±¦¼¼ÈîÂç¤Ï¿ÇÃǤǤ­¤Ê¤¤¡¥ ¿ÇÃǤÏIRBBB¡¤1¡ë¥Ö¥í¥Ã¥¯¡¤LVH¡¥¡¥¤·¤ç¤²¤ë¡¥V6¤ÎS¤Ëµ¤¤¬¤Ä¤¤¤Æ¤¤¤Ê¤¤¡¥ GE #34 1¡ë¥Ö¥í¥Ã¥¯¡¤V1-3¤Î1ÇïÌܤÏWPWÍ;弼À­´ü³°¼ý½Ì¤Ë¸«¤¨¤ë¤¬¿ÇÃÇ¤Ë µ­½Ò¤Ê¤·¡¥ GE #35 Af¡¤V1¤ÎQR¡¤V2¤ÎrSR'¤½¤·¤ÆV6¤ÎsÇȤˤè¤êIRBBB¡¥ V1¤ÎQÇȤϹ¼ºÉÇÈ·Á¤Ç¤Ï¤Ê¤¤¡¥V2¤Ç¤ÏrSR'¤Ë¤Ê¤Ã¤Æ¤¤¤ë¤¿¤á¡¥ GE #36 Af, digitals, LVH¡¥ GE #37 II, III, aVF¤ÎSTD, digitaris¤ÎTÇÈ¡¤1¡ëAV- Block, V2-V4¤Î¶¯¤¤STD¡¤ Puls 125¤Ë¤è¤ëµõ·ìÊѲ½¡¥old Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ ¿ÇÃÇ¡§¾å¤Ç¹ç¤Ã¤Æ¤¤¤ë¤¬¥¸¥®¥¿¥ê¥¹¤Ç¤Ï¤Ê¤¤¡¥ GE #38 normal ECG¡¥ GE #39 tachy, lafb, old a-s MI, ¿ÇÃÇ¡§PÇȤʤ¯¡¤SVT¡¥Â¾¤Ï¹ç¤Ã¤Æ¤¤¤ë¡¥ GE #40 º¸Ë¼ÈîÂ硤V1-2¤¬QS¤À¤¬Àµ¾ï¤«¡© ¿ÇÃÇ¡§¸Å¤¤Ãæ³Ö¹¼ºÉ¤È¤·¤Æ¤â¤è¤¤¡¥V5-6, I, aVLÁ´¤Æ¤¬Ù¨Ê¿TÇÈ¡¥ GE #41 ±¦¼´Êа̡¤LAE,RAE, V1¤ÏrsR'¤ÇT¥¹¥È¥ì¥¤¥óµÕž¡¤V6¤ÇÂ礭¤ÊRSÇÈ¡¤±¦¼¼ÈîÂç¡¥ ¤³¤ÎV1¤ÏIRBBB¤È´Ö°ã¤¦¡¥V6¤ÎSÇȤ¬¥¹¥é¡¼¤Ç¤Ê¤¤¤³¤È¤ËÃí°Õ¡¥ QRS 0.9¤¬¥Ö¥í¥Ã¥¯¤Ç¤Ê¤¤¾Úµò¤Î°ì¤Ä¤Ç¤¢¤ë¡¥ ÇÙÀ­¿´ GE #42 ξ¿´Ë¼ÈîÂ硤¼´90¡ë¡¤II,III,aVF¤ÎqÇÈ¡¤1SQ3T3¡¤»þ·×²óž¡¤ V6¤ÎTʿó¡¥I¤ÎÄãÅÅ°Ì¡¥²¼Êɹ¼ºÉ¤È¤¹¤ë¤ÈTÇȤÎÊѲ½¤¬¾¯¤Ê¤¤¡¥ ¶»Éô¤ÎrS¤è¤ê±¦¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§ÇÙµ¤¼ð¡¥ ÇÙÀ­¿´¡¤Ãæ³ÖQÇÈ GE #43 AF¡¤II,III,aVF¤ÎÉý¹­Â礭¤ÊQS·¿¡¥I,II¤è¤ê¿´¼¼¥Ú¡¼¥·¥ó¥°¡¥ V1¤ÏV1-5¤Þ¤ÇQS·¿¡¤V6¤ÇrS·¿¡¤V6¤ÇRÇȤˤʤé¤Ê¤¤¤¿¤áLBBB¤È¤Ê¤é¤º IVCD¤È¤Ê¤ë¡¥±¦¼¼¿´ÀíÉô¥Ú¡¼¥·¥ó¥°¤À¤Èº¸µÓ¥Ö¥í¥Ã¥¯¡¤¼´¤Ï-60°Ê²¼¤Ë¤Ê¤ë¡¥ GE #44 ¸Å¤¤²¼Êɹ¼ºÉ¡¤ÅṲ̋è¤êº¸¼¼ÈîÂç¡¥¥¸¥®¥¿¥ê¥¹¡¥ ¿ÇÃÇ¡§II,III¤ËrÇȤ¬¸«¤¨¤ë¤«¤é²¼Êɹ¼ºÉ¤Ç¤Ï¤Ê¤¤¡¥ GE #45 ¼´¿åÊ¿¡¤V5-6, I, aVL¤ÎȿžTÇÈ¡¤II, III, aVF¤ÎȿžTÇÈ¡¥PÇȤϤʤ¤¡¥Ë¼¼¼Ä´Î§¡¥ ¿ÇÃÇ¡§accelerated nodal rhythm. ²¼ÊɤÎNon-Q-MI¤È¿ÇÃǤ¹¤ë²ÄǽÀ­¤â¤¢¤ë¤¬¡¤ Î×¾²¾É¾õ¤¬¤Ê¤¤¤«¤®¤ê¡¤¤½¤ì¤È¤Ï¿ÇÃǤǤ­¤Ê¤¤¡¥ GE #46 V1-3¤ÎQS¡¤STE¡¤PVC¿ȯ¡¤V6, I, aVL¤Îflat TÇÈ¡¥Á°ÊÉÃæ³Ö¹¼ºÉ¡¤¿´¼¼áî¤Î²ÄǽÀ­¤â¤¢¤ë¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #47 1¡ëAV Block, ½ùÌ®¤Ë³¤¯VT¡¥ ¿ÇÃÇ¡§¿´Çï150¤À¤«¤é2:1¤ÎAF¤È¤â¹Í¤¨¤é¤ì¤ë¤¬QRS¤ÎÉý¤¬¹­¤¤¤¿¤á¤ËSVT¤Ç¤Ï¤Ê¤¯VT¤Ç¤¢¤ë¡¥ GE #48 ¿´Ë¼¥»¥ó¥¹¿´¼¼¥Ú¡¼¥·¥ó¥°¡¤±¦µÓ¥Ö¥í¥Ã¥¯·¿¡¥ ¿ÇÃÇ¡§¥Ú¡¼¥·¥ó¥°¤ÏCRBBB¡ÜLAFB·¿¡¥ GE #49 ±¦Ë¼ÈîÂ硤IVCD¡¤III, aVF¤ÎȿžTÇÈ¡¥º¸¼¼¹âÅÅ°Ì¡¥ ¿ÇÃÇ¡§IIIͶƳ¤Î¿¼¤¤È¿Å¾TÇȤò¸«¤ë¤È non-Q-MI¤ò»×¤ï¤¹¡¥ GE #50 V5¤¬QS¤Ë¸«¤¨¤ë¤¬¡¤ÅŶˤΰì´Ö°ã¤¤¡¥V6, I, aVL¤Îflat TÇȤ¬´ü¤Ë¤Ê¤ë¡¥ GE #51 3¡ëAV Block, Â¥¿Ê˼¼¼Ä´Î§¡¥ÉÑÌ®V4-6¤È»Í»èͶƳ¤Î¤ÎSTD¡¥ ¿ÇÃÇ¡§Af¤ÈÉÑÌ®¤ÈÉÑÌ®¤Ë¤è¤ëSTD¡¥ GE #52 II, III, aVF¤Î°Û¾ïQÇÈ¡¤v2-6¤Î¶¯ÅÙ¤ÎSTD¡¤TÇȤϾå¸þ¤­¡¥I,aVL¤Î¥ß¥é¡¼STD¡¥²¼Êɱ¦¼¼¹¼ºÉ¡¥ ¿ÇÃÇ¡§±¦´§Æ°Ì®ËÜ´´¤Î¹¼ºÉ¡¥±¦¼¼¹¼ºÉ¤Îµ­½Ò¤Ï¤Ê¤¤¡¥II¤è¤êIII¤ÎSTE¤¬¶¯¤¤¡¤ V6¤ÎSTD¤Ç¸åÊɹ¼ºÉ¤Ï½ü³°¤Ç¤­¤ë¡¥ GE #53 º¸¼´Êа̡¤È¿»þ·×²óž¡¤ST¤¬¿åÊ¿¡¤LQT¡¥ ¿ÇÃÇ¡§¤Û¤ÜÀµ¾ï¡¥flat ST's in inferolateral leads¤Ï½ê¸«¡¥ GE #54 PVCÉÑȯ¡¤Ëß¾õTÇÈ¡¤¥¸¥®¥¿¥ê¥¹¸ú²Ì¡¥ ¿ÇÃÇ¡§PÇȤÏÀµ¾ïĴΧ¤ÇÊѲ½¤Ï¤Ê¤¯¡¤´ÖÂÚÀ­PVC¤Ç¤¢¤ë¡¥II¤ÈV1¤«¤éLAA¤Ç¤¢¤ë¡¥ GE #55 II,III,aVF¤ÎSTE¤ÈȿžTÇÈ¡¤V5-6¤ÎȿžTÇÈ¡¥°Û¾ïQÇȤϤʤ¤¡¥º¸¼¼ÈîÂç¤Ç¤Ï¤Ê¤¤¡¥²¼ÊÉMI¤Î²ÄǽÀ­¡¥ ¿ÇÃÇ¡§²¼Êɹ¼ºÉ¤Î·ìÀòÍϲò¸å¡¥ GE #56 I¡¤aVL¤ÎSTD¡¥¤½¤Î¤Ä¤â¤ê¤Ç¤ß¤ë¤È¡¤II¡¤III¡¤aVF¤ÎSTE¤ÈȿžTÇÈ¡¥V5¤ÎSTD¡¤ V6¤Î¿åÊ¿¡¤È¿Å¾TÇÈ¡¥µÞÀ­²¼Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§µÞÀ­²¼Êɹ¼ºÉ¡¥ GE #57 V1¡ÁV3¤Þ¤ÇRS¤Ç¹â¤¤TÇÈ¡¤V4¡ÁV6¤Ë½¾¤Ã¤ÆRÇȤϾ®¤µ¤¯V6¤ÏQS¤ÇSTE¡¥ ¤ß¤¿¤³¤È¤â̵¤¤ÇÈ·Á¡¥±¦¼¼ÈîÂç¡©»Í»èÄãÅÅ°Ì¡¥ ¸åÊɤÎAMI¡¥V1¤ÎRÇȤϸåÊɹ¼ºÉ¤Î¤¿¤á¡¤¤â¤·¸åÊɹ¼ºÉ¤ÇSTE¤¬È¯À¸¤¹¤ë ¤Þ¤Ç¤Î´Ö¤Ç¤¢¤ì¤Ð¡¤V1¡ÁV3¤Þ¤Ç¤Î¥ß¥é¡¼STD¤ÏȯÀ¸¤·¤Ê¤¤¡¥V5¡ÁV6¤ÎSTE¤Ï Àµ¤·¤¯AMI¤ò¼¨¤·¡¤II,III,aVF¤ÎÊѲ½¤Ï¤Ê¤¤¤«¤é±¦´§Æ°Ì®¤ÏÀµ¾ï¡¥ ½¾¤Ã¤Æ¡¤º¸²óÀû»Þ¤ÎÊĺɤˤè¤ë¦ÊɸåÊɹ¼ºÉ°Ê³°¤Ë¹Í¤¨¤é¤ì¤Ê¤¤¡¥ GE #58 Nodal, PÇȤ¬¸«¤¨¤Ê¤¤¡¥I, aVL¤Î²¼¹ßST¡¤µÕžTÇÈ¡¤V4-6¤Þ¤Ç¤ÎµÕžTÇÈ¡¥ ¿ÇÃÇ¡¤II,III,aVF¤ÎµÕžT¤òÍ­°Ù¤È¹Í¤¨¤ÆNon-Q-MI¤ò¹Íθ¤¹¤ë. GE #59 I¡¤aVL¤Î¿åʿȿžTÇÈ¡¥V1-3¤Î°Û¾ïQÇȤÈSTE¡¥PVC¡¥µÞÀ­Á°Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§µÞÀ­Á°Êɹ¼ºÉ¡¥ GE #60 AF¤È±¦¼¼ÈîÂç PÇȤ¬¸«¤¨¤Ê¤¤¤¬V1¤ò¸«¤ë¤È4:1¤ÎAF¤Ç¤¢¤ë¡¥ 110¡ë¤Î±¦¼¼Êа̤ÈV1¤ÎÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¡¤TÇȵÕž¤ÏV1-v3¤Þ¤Ç¤¢¤ê¡¤ V6¤ÎSÇȤÏÍ­°Õ¤ËÂ礭¤¤¡¥»Í»èͶƳ¤Ï±¦¼´Êа̤ÈÄãÅÅ°Ì¡¤II, III, aVF¤Î ²¼¹ß¤¹¤ëST¥»¥°¥á¥ó¥È¤È¾å¸þ¤­TÇȤϿ´¶Úµõ·ì¤ò»×¤ï¤¹¤¬¡¤¼ç¤¿¤ë½ê¸«¤Ç¤Ï¤Ê¤¤¡¥ GE #61 I,aVL¤ÎȿžTÇÈ¡¤V1-4¤ÎSTE¤ÈȿžTÇÈ¡¥Á°ÊÉÃæ³Ö¹¼ºÉ¤Î½é´ü¡¥ ¿ÇÃÇ¡§V2¤ËrÇȤ¬¤¢¤ë¤¿¤á¤ËnonQ-MI¤Î²ÄǽÀ­¤¢¤ê¡¥ GE #62 I,aVL¤ÎSTD¡¤II,III,aVL¤ÎSTE¤ÈȿžTÇÈ¡¥V3-6¤ÎSTD¡¥²¼Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§²¼Êɹ¼ºÉ¤ÎµÞÀ­´ü¡¥ GE #63 ¿´Ë¼¥Ú¡¼¥·¥ó¥°¡¥Ã±¶Ë¥Ú¡¼¥·¥ó¥°¤À¤«¤éÅṲ̋ÏÂ礭¤¯¥¹¥Ñ¥¤¥¯¤¬¥Æ¡¼¥ê¥ó¥°¤¹¤ë¡¥ GE #64 ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¡¤ GE #65 1¡ëAV¥Ö¥í¥Ã¥¯¡¤¥¸¥®¥¿¥ê¥¹¸ú²Ì UÇȤòQTc¤Ë²Ã»»¤·¤Æ¤¤¤ë¡¥¿åÊ¿ST¤ä²¼¹ßST¤Ï¥¸¥®¥¿¥ê¥¹¸ú²Ì¡¥ GE #66 ÉÑÌ®¡¤II,III,aVF¤ÎSTE¡¥I,aVL¤ÎSTD¡¥V5-6¤ÎȿžTÇÈ¡¥²¼Êɹ¼ºÉ¤ÎµÞÀ­´ü¡¥ ¿ÇÃÇ¡§V6¤Ë¾¯¤·¤ÎSTE¤¬¤¢¤ë¤¿¤á¤Ë²¼ÊɦÊɹ¼ºÉ¤Ç¤¢¤ë¡¥V4¤ÎSTD¤Ï¥ß¥é¡¼¸ú²Ì¡¥ GE #67 ½ùÌ®¡¤I,aVL, V2-5¤Î¶¯¤¤È¿Å¾TÇÈ¡¥nonQ-MI. ¿ÇÃÇ¡§¾åµ­¤ÈƱ¤¸¡¥non-Q infarction. GE #68 ±¦µÓ¥Ö¥í¥Ã¥¯¡¤II,III,aVF¤ÎSTE¡¤V5-6¤ÎSTE¡¤V2-3¤ÎSTD¡¥µÞÀ­²¼ÊÉ¡¤Â¦ÊÉ¡¤¸åÊɹ¼ºÉ¡¥ ¿ÇÃÇ¡§²¼ÊɦÊɹ¼ºÉ¡¥¸åÊɤε­½Ò¤Ï¤Ê¤¤¡¥¤Þ¤¿±¦µÓ¥Ö¥í¥Ã¥¯¤Îµ­½Ò¤â¤Ê¤¤¤¬¡¤ I¡¤V2-3¤ÎÂ礭¤ÊRÇȤϱ¦µÓ¥Ö¥í¥Ã¥¯¤ò¼¨º¶¤¹¤ë¡¥ GE #69 º¸¼´Êа̡¤LAFB¡¥PRP¡¤Ê¿Ã³±¢À­TÇÈ¡¥ ¿ÇÃÇ¡§1¡ëAV¥Ö¥í¥Ã¥¯¡¤NSTWC's¡¥ GE #70 ½ùÌ®¡¤1¡ëAV¥Ö¥í¥Ã¥¯¡¤V5-6¤ÎSTD¤ÈËß¾õTÇÈ¡¥¥¸¥®¥¿¥ê¥¹¸ú²Ì¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #71 ÊèÀÐÍÍÇÈ·Á RBBB¤ËÁ°ÊɦÊÉAMI¤¬È¯À¸¡¥II¡¤aVF¤âSTE¤À¤«¤é¡¤µÞÀ­²¼Êɹ¼ºÉ¤âȯÀ¸¤·¤Æ¤¤¤ë¡¥ V1-5¤Þ¤Ç°Û¾ïQÇÈ¡¥ GE #72 1¡ëAV Block¡¤LQT¡¤ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #73 ¼´-60 V1-V5¤Þ¤ÇrS¤Ç»÷¤¿ÇÈ·Á¡¤V6¤ÏRS¤À¤¬S¤ÎÊý¤¬Â礭¤¤¡¥ LAFB, QRSÉý¤¬0.14¤À¤«¤é,¤Þ¤¿¥Î¥Ã¥Á¤¬¤¢¤ë¤¿¤áIVCD¡¥ GE #74 WPW¡¥ GE #75 *I¡¤aVF¤è¤ê±¦¼´Êа̡¤»Í»èÄãÅÅ°Ì¡¤»Í»è¤Ç¤ÏÉÔÌÀÎƤÀ¤¬V1¤ÎPÇȤè¤ê±¦Ë¼ÈîÂç¡¥ V1¤ÎRÇȤÈV1-3¤ÎȿžTÇȤè¤êRVH¡¥ ¿ÇÃÇ¡§V6¤ÎSÇȤâ½ÅÍס¥Éý¤¬¶¹¤¤¤³¤È¤«¤éIRRB¤Ç¤Ï¤Ê¤¤¡¥cor pulmonale. GE #76 Axis -30°Ê²¼¡¤ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ ¿ÇÃÇ¡§ÉÑÌ®¡¤LAA¡¤¿´ÉÔÁ´¤òͽÁÛ¤·¤Ê¤±¤ì¤Ð¤Ê¤é¤Ê¤¤¡¥ GE #77 ?ÉÑÌ®¡¤CLBBB¡¤ÉÑÌ®¤Ë¤è¤ëSTD¡¥V6¤ËSÇȤ¬¤Ê¤¤¡¥ ¿ÇÃÇ¡§2:1¤ÎAF¡¤V5-6,I¤Ï¾®¤µ¤¤¤¬°Û¾ïQÇȤǤ¢¤ë¡¥II,III,aVF¤â°Û¾ïQÇÈ¡¤¤·¤¿¤¬¤Ã¤Æ²¼ÊɦÊɹ¼ºÉ¡¥ GE #78 ?4:1¤ÎAF¡¤PVC¡¤IRBBB¡¤CLBBB¡¥V4-5¤Î°Û¾ïQÇȤÏÍý²ò¤Ç¤­¤º¡¥Á°Êɹ¼ºÉ¤«¡© ¿ÇÃÇ¡§AF¤Ç¤¢¤ë¤¬R-R´Ö³Ö¤ÏÉÔÄê´ü¡¥IRBBB¤Ë¤Ä¤¤¤Æ¤Îµ­½Ò¤Ï¤Ê¤¤¡¥ GE #79 ÄĵìÀ­²¼Êɹ¼ºÉ¡¥»þ·×²óž¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #80 CLBBB¤Ë¸«¤¨¤ë¤¬i, aVL¤ËqÇȤ¬Â¸ºß¤¹¤ë¡¥ ¿ÇÃÇ¡§LAFB¡¤IVCD¡¤PAP¡¤LAA¡¥ GE #81 QRS 0.16, I,aVL¤ÏCLBBB¤ÎV6¤ÎÍͤËÉý¹­RÇÈ¡¤II,III,aVF¤ÏQSÇÈ¡¤ V1¤ÏCLBBBÍÍrSÇÈ¡¤V6¤ÏrsR'S'¤Ç±¦µÓ¥Ö¥í¥Ã¥¯ÍÍ¡¥IVCD¡¥Long-QT¡¥ ¿ÇÃÇ¡§ÅŲò¼Á¸¡ººÉ¬Íס¥ GE #82 II,III,aVF¤ÏQS¡¤I,aVF¤Ï¿åÊ¿ST¡¤I¤Î°Û¾ïQÇÈ¡¤V5,V6¤ÏQSÇÈ¡¤ÆÌTÇÈ¡¤ ¸Å¤¤²¼ÊɦÊɹ¼ºÉ¡¤LAFB¡¥ ¿ÇÃÇ¡§II,III,aVF¤ÎQS¤Ï¼´<-60¤Ç¤¢¤ë¤«¤é¡¤LAFB¤ÎŬ±þ¤Ë¤Ê¤ë¤¬¡¤ ¹¼ºÉ¤Î¾ì¹çLAD¤ÇLAFB¤Ï¿ÇÃǤǤ­¤Ê¤¤¤È¤¤¤¦¡¥¤·¤«¤·peri-infarction block ¤ò¤¤¤¦¤Ê¤éLAFB¤Ï¿ÇÃǤ·¤Ê¤±¤ì¤Ð¤Ê¤é¤Ê¤¤¤È»×¤¦¡¥ GE #83 Af, QRS 0.8, I¤ÏR¡¤II¡¤III¤ÏrS¡¤aVL¤Ë¾®¤µ¤ÊqÇÈ¡¤»Í»è¤ÎT¤ÏÁ´¤ÆµÕž¡¥ V1¤Ïº¸µÓ¥Ö¥í¥Ã¥¯ÍÍrS¤Þ¤¿¤ÏSÇÈ¡¤V2¡ÁV4¤ÏrSÇÈ¡¤V5,V6¤ÏRsÇÈ¡¤IVCD¡¤LAFB¡¥ ¿ÇÃÇ¡§¾åµ­¤ÈƱ¤¸¡¥ GE #84 normal ECG GE #85 Á´ÂÎŪ¤ËÄãÅÅ°Ì¡¤STʿó¡¤T±ú¡¤ ¿ÇÃÇ¡§cardiomyopathy¤ÇÆðۤʽ긫¤Ï¤Ê¤¤¡¥ GE #86 II,III,aVF¾®¤µ¤ÊQÇÈ¡¤V4¡ÁV6STD¿åÊ¿T¡¥µõ·ì¡¤¸Å¤¤IWMI¤«¡© ¿ÇÃÇ¡§STD¤Ï¥¸¥®¥¿¥ê¥¹¤Îsagging¡¥QÇȤÏÍ­°Ù¤Ç¤Ï¤Ê¤¤¡¥ GE #87 QRS 0.12, II,III,aVF¤ÏQr¡¤Af¡¤V1¡ÁV6¤Þ¤ÇrSÇÈ¡¥T¤ÏV6°Ê³°¾å¸þ¤­¡¥ ¼´¤Ï-50¡ë¡¥Af¤À¤«¤éPÇȤοÇÃǤ¬¤Ç¤­¤Ê¤¤¤¬¡¤IWMI¡¥ ¿ÇÃÇ¡§IWMI¡¤IVCD¡¥V6¤¬rS¤Ç¤Ê¤¯¾®¤µ¤ÊQS¤Ç¤¢¤ë¤¬¡¤IVCD¤Ë¤¹¤ë¡¥ Ge #88 ƶÉÔÀ°Ì®¡¤V5,V6¤ÎSTD¡¥ ¿ÇÃÇ¡§wandering P, digoxine¤Îsagging T. Ge #89 BER. ¿ÇÃÇ¡§¹âK·ì¾É¡¥ GE ?#90 IVCDÍͤÎVT¡¥¹âK·ì¾É¡¥ ¿ÇÃÇ¡§aVR¤ÇPÇȤ¬¸«¤¨¤ë¤«¤éSVT¡¥ GE #91 GE #92 II, III, aVF¤Î¾®¤µ¤Ê°Û¾ïQÇȤÈTÇÈȿž¡¥¸Å¤¤¿´¶Ú¹¼ºÉ¡¤V1¤Î RÇȤÏÀµ¾ïÈÏ°Ï¡¤È¿»þ·×²óž¡¤¶»Éô¤ÇUÇȤ¬¸«¤¨¤ë¤¬Àµ¾ïÈÏ°Ï¡¥ GE #93 ¶¯¤¤»þ·×²óž¡¤¶»ÉôͶƳ¤Ï¿¼¤¤È¿Å¾TÇÈ¡¤Non-Q MI. GE #94 ƶÀ­ÉÑÌ®¤Î¥Ú¡¼¥·¥ó¥°¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #95 »Í»èÄãÅÅ°Ì¡¤II,III,aVF¤ÎSTE¡¤aVL¤Î¥ß¥é¡¼STD¡¤V2-3¤Î¥ß¥é¡¼STD¡¤V5-6¤ÎSTE¡¥ÃæÀ¤²¼ÊɦÊɹ¼ºÉ¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥¿´³°Ëì±ê¤Ç¤Ï¥ß¥é¡¼STDÇÈȯÀ¸¤·¤Ê¤¤¡¥ GE #96 LAE, CRBBB·¿ÊѹÔÅÁƳ¡¤V2-4¤ÎSTDȿžTÇÈ¡¥Á°ÊɦÊɤÎnon-Q IM¤Îµ¿¤¤¡¥ ¿ÇÃÇ¡§ÊѹÔÅÁƳ¤Ç¤Ï¤Ê¤¯PVC¤È¤·¤Æ¤ë¡¥ GE #97 LAA, PVC, ÄĵìÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ILBBB. ¿ÇÃÇ¡§Axis -50¤ÇLAFB¡¤PÇȤ¬QRSľ¸å¤Ë¾è¤Ã¤¿ectopic beat(°Û½êÀ­ÇïÆ°)¡¤V6¤ËSÇȤ¬¤Ê¤¤¡¥ ? II,III,aVF¤ÇȯÀ¸¤¹¤ëÍÛÀ­TÇȤÏÀµ¾ï¤«°Û¾ï¤«¡© Åú¤¨¡§°Û¾ïTÇȤǤ¢¤ë¡¥I,IIͶƳ¤Ç¤Ï¾å¸þ¤­R¤Ç²¼¸þ¤­TÇÈ¡¥¤½¤ÎÍý¶þ¤Ê¤éII,III,aVF¤ÏÁ´¤Æ °Û¾ï¤ÊȿžTÇȤǤʤ±¤ì¤Ð¤Ê¤é¤Ê¤¤¡¥ GE #98 ƶÀ­ÉÔÀ°Ì®¡¤È¿»þ·×²óž¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥ GE #99 aVR¤ò¤Î¤¾¤¯Á´¤Æ¤ÎͶƳ¤ÇSTE¡¤PR´Ö³Ö¤ÎÄã²¼¡¤¿´³°Ëì±ê¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥
GE100Ìܼ¡¤ËÌá¤ë¡£
GE #100 Á°ÊÉÃæ³Ö¹¼ºÉ¤Ë¤è¤ëCRBBB+LPFB¡¥1¡ëAV block ¿ÇÃÇ¡§Â¿¤¯¤Îʬ»Þ¥Ö¥í¥Ã¥¯¤ÏMI¤È´Ø·¸¤Ê¤¤¤¬¡¥¤³¤ì¤Ï"peri-infarction block"¤Ç¤¢¤ë¡¥ GE #101 PR 0.24, È¿»þ·×²óž¡¤V3¡ÁV5¤ÎSTD¡¤µõ·ì¡¥ ¿ÇÃÇ¡§L-QT, NSSTWC. paroxysmal AF¤ÎͽËɤËquinidine¤òÉþÍÑ¡¥ TÇȤΥơ¼¥ê¥ó¥°¤ËÃí°Õ¡¥ GE #102 wanderling P, PAC, LAD, ¿ÇÃÇ¡§Multifocal atrial tachycardia (MAT) GE #103 Junctional rhythm ¿ÇÃÇ¡§Nodal bradycardia, rectrograde P. GE #104 I,aVL¤ÏSTE¡¤II¤ÏRS¤Ç¾å¸þ¤­T¡¤III,aVF¤ÏSTD¾å¸þ¤­TÇȤǥߥ顼¡¤ V1¤ÏrS¤ÇSTDȿžTÇÈ¡¤V2,V3¾å¸þ¤­ÍÛÀ­TÇÈ¡¤V4,V5,V6¤ÏSTEÊèÀÐÍÍTÇÈ¡¤ Á°ÊɦÊɹ¼ºÉ¡¥ GE #105 LAFB+CRBBB, V2¤À¤±STE¤Ç¤¢¤ë¤¬¡¤CRBBB¤Ë¤è¤ëÊѲ½¡¥ ¿ÇÃÇ¡§V2¤Î¤ß¤Ê¤é¤º¡¤V1¤«¤éV3¤Þ¤ÇSTE¤Ç¤¢¤ë¤«¤é¡¤µÞÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¤Ç¤¢¤ë¡¥ GE #106 GE #106 CLBBB¤ÈLVH¡¥Axis -60¡ë¤ÇLAD¡¥¤·¤«¤·LAFB¤È¤Ï¿ÇÃǤ·¤Ê¤¤¡¥ V1¤ÎrÇȤÏÌÀ¤é¤«¤Ç¤Ï¤Ê¤¤¡¥V6¤ÏRÇȤΤߤÇsÇȤϤʤ¤¡¥±¦¼¼Êɤò¼¨¤¹sÇȤϱ¦µÓ¤¬Àµ¾ï ¤Ç¤¢¤ë¤¿¤á¤Ë¤¹¤Ç¤Ëæʬ¶Ë¤·¤Æ¤¤¤ë¡¥º¸¼¼¹â°Ì¦Êɤζ½Ê³¤Ï¿´ÀíÉô¤ÈƱ¤¸ ¥¿¥¤¥ß¥ó¥°¤Ç¤¢¤ë¤«¤ésÇȤÏȯÀ¸¤·¤Ê¤¤¡¥ GE #107 LAFB¡¥PRP¡¥ GE #108 Àµ¾ï¤Î¤è¤¦¤Ë¸«¤¨¤ë¤¬II, III, aVF¤ÎSTE¡¥I, aVL, V2¤ÎSTD¤è¤ê½é´ü¤Î²¼Êɹ¼ºÉ¡¥ GE #109 Eisenmenger, ±¦¼¼ÈîÂ硤±¦¼´Êа̡¤ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¤Ë¸«¤¨¤ë¤¬¡¥VͶƳ¤Ç¥·¥ã¡¼¥×¤ÊSÇÈ·Á¡¥ GE #110 ξ¿´Ë¼ÈîÂç¤ÈSTȿž¤òȼ¤¦LVH¡¥ GE #111 AF, IRBBB¡¥ ¿ÇÃÇ¡§V5,V6¤ÎRÅÅ°Ì¡¤STD¤è¤êº¸¼¼³ÈÄ¥¡¥Marfan's syncrome¤ÈAR¡¥ GE #112 PÇȤϤʤ¯¡¤Ë¼¼¼Ä´Î§¤Î½ùÌ®¡¥V2-5¤Î±¢À­TÇȤǤ¢¤ë¤¬¡¤¿¼¤¯¤Ê¤¯¿´ÆâËì²¼¹¼ºÉ¤Ç¤Ï¤Ê¤¤¡¥ ¿ÇÃÇ¡§½ùÌ®À­ÀܹçÉôĴΧ¡¤PRP¡¥NSST-TWC's. GE #113 GE #114 GE #115 GE #116 Accerated juctional rhythm, pericarditis GE #117 4:1AF¡¤LVH¡¤V1¤ÎQÇȤÏÀµ¾ï¡¥¥¸¥®¥¿¥ê¥¹¸ú²Ì¡¥ ¿ÇÃÇ¡§STD¤Ç¤¢¤Ã¤Æ¤âTÇȤϾå¸þ¤­¤À¤«¤éLVH¤Î±Æ¶Á¡¥ GE #118 1¡ëAV ¥Ö¥í¥Ã¥¯¡¤CLBBB¤ËPVC¡¥ ¿ÇÃÇ¡§3:2 Wenckebach¡¤ GE #119 *CLBBB GE #120 LAE, RAE, LVH GE #121 *II, aVF¤¬¡Ý¤À¤«¤é¼´¤Ï-30¡ë°Ê²¼¡¤V1¤¬PVC¤Î¤è¤¦¤Ë¸«¤¨¤ë¤¬µðÂç¤ÊrsR' ¤Ç¤¢¤ë¡¥V1-V3¤Þ¤ÇrsR'¤ÇȿžTÇÈ¡¤V4-V6¤ÏrSÇȤÇÍÛÀ­TÇÈ¡¥ ¿ÇÃÇ¡§LAFB+CRBBB¡¥ËÜÍèRBBB¤Ï±¦¼¼ÈîÂç¤Î¿ÇÃǤϽÐÍè¤Ê¤¤¤¬¡¤ V1¤Î°Û¾ï¤Ê¹â¤µ¤ÎR'¤ÈV6¤ÎSÇÈ¡¤¤½¤·¤ÆȿžTÇȤÏRVH¤òµ¿¤ï¤»¤ë¡¥ Ä̾ï¤ÎCRBBB¤Ç¤ÏV6¤ÏRÇȤÈÉý¹­¤ÎSÇȤǤ¢¤ë¤¬¡¤RVH¤Ç¤ÏRÇȤ¬¾®¤µ¤¯¡¤ SÇȤϱԤ¯¿¼¤¤¡¥ GE #122 II¡¤III¡¤aVF¤Î¾®¤µ¤ÊqÇÈ¡¤ST¤ÏÀµ¾ïÇÈ·Á¡¥VͶƳ¤ÏÈ¿»þ·×²óž¤ÇÀµ¾ï¡¥Æ¶Ä´Î§¤ÇPR¤Ï160ms¡¥¤Û¤ÜÀµ¾ïÇÈ·Á ¿ÇÃÇ¡§°Û¾ïQÇȤȤ·¤Æ¸«¤ë¤«¤É¤¦¤«¤ÏÆñ¤·¤¤¡¥ GE #123 I¡¤aVL¤ª¤è¤ÓV1-6¤Þ¤Ç¤ÎȿžÂоÎTÇÈ¡¥¿´ÆâËì¹¼ºÉ¡¥ ¿ÇÃÇ¡§ÈóQÇÈÀ­Á°Êɹ¼ºÉ¡¥LQT¤¬¤¢¤ê¡¤VT¤Ë¤Ê¤ê¤ä¤¹¤¤¡¥ GE #124 II¡¤III¡¤aVF¤Î°Û¾ïQÇȤÈSTE¡¥I¡¤aVL¤ÎSTE¤ÈȿžTÇÈ¡¥¶»Éô¤ÏV1¤¬RSÇȤǰܹÔÂÓ¡¥¶Ëü¤ÊÈ¿»þ·×²óž¡¥ µÞÀ­²¼Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§µÞÀ­²¼Êɹ¼ºÉ¡¥V1-2¤ÎSTD¤â½ê¸«¤ËÆþ¤ì¤ë¡¥ GE #125V1¤è¤ê±¦¼¼ÅÁƳÃٱ䡥 Àµ¾ï¿´ÅÅ¿Þ¡¥ GE #126 II¡¤III¡¤aVF¤ÎSTE¤ÈV2-4¤ÎSTD¡¥I¡¤aVL¤ÎSTD¡¥µÞÀ­²¼Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡¨µÞÀ­Á°Êɹ¼ºÉ¤È¿ÇÃǤ·¤Æ¤¤¤ë¤¬¡¤¤ï¤«¤é¤ó¡¥ GE #127 ƶÀ­ÉÑÌ®¡¤º¸Ë¼ÈîÂ硤LQT¡¤LVH¡¤¥¹¥È¥ì¥¤¥óTÇÈ¡¥ ¿ÇÃÇ¡§aortic stenosis¤Ë¤è¤ëLVH¡¥ GE #128 GE #129 GE #130 V1-2¤ÎQSÇÈ·Á¤è¤êÁ°Êɹ¼ºÉ¤Î²ÄǽÀ­¤¬¤¢¤ë¤¬¡¢Àµ¾ï¤«¤â¤·¤ì¤Ê¤¤¡¥ GE #131 IRBBB¤Ç¤¢¤ë¤¬¡¤V1¤ÎTÇȤϵÕž¤·¤Æ¤¤¤ë¡¥±¦¼´Êа̤Ǥ¢¤ì¤Ð ±¦¼¼ÈîÂç¤Î²ÄǽÀ­¤¬¤¢¤ë¤¬¡¤¤³¤ÎÅŵ¤¼´¤Ï45¡ë¤À¤«¤é¡¤Î×¾²¾É¾õ¤¬È¼¤ï¤Ê¤±¤ì¤ÐÌäÂê»ë¤·¤Ê¤¤¡¥ GE #132 PRû½Ì¡¤´§ÀÅ̮ĴΧ¡¤È¿»þ·×²óž¡¤WPW¤Î²ÄǽÀ­¤Ï¤¢¤ë¡¥ ¿ÇÃÇ¡§low atrial or coronary sinus pacemaker¤Ç¾å¤ÈƱ¤¸¡¥ GE #133 ¼´-30Åٰʾ塤LAFB¸Í¿ÇÃǤ·¤¿¤¤¤¬¡¤V1-6¤Þ¤ÇrS¤Ç¤¢¤ë¡¥·Á¤È¤·¤Æ¤ÏIVCD¤Ç¤¢¤ë¤¬¤¬¡¤QRSÉý¤¬¶¹¤¤¡¥ ¿ÇÃÇ¡§°ìÈÌŪ¤Ë²¼Êɹ¼ºÉ¤Î¾ì¹ç¤ÏII¡¤III¡¤aVF¤ÇQSÇȤˤʤ뤿¤á¡¤LAFB¤È¤Ï¿ÇÃǤ·¤Ê¤¤¡¥ ¤³¤ÎÎã¤Ç¤ÏII¤ËrÇȤ¬¤¢¤ë¤«¤é²¼Êɹ¼ºÉ¤Ç¤Ï¤Ê¤¯¡¤¤Þ¤¿V2¤ËrÇȤ¬¤¢¤ë¤¿¤á¡¤Á°Êɹ¼ºÉ¤Ç¤Ï¤Ê¤¤¡¥ ³ÈÄ¥À­¿´¶Ú¾É¤Ç¤¢¤ë¡¥ GE #134 *AF¡¤ÉÑÌ®¡¤II¡¤III¡¤aVF¤ÎSTD¡¤V2-6¤Î¹âÅÅ°Ì¡¤STD¤¬¤¢¤ê¡¤LVH¡¥¶ì¤·¤½¤¦¡¥ ¿ÇÃÇ¡§AF¡¤ÉÑÌ®¤Ë°Í¸¤¹¤ëSTD¡¥º¸¼¼¹âÅṲ̋Ϥʤ¤¡¥»Í»èͶƳ¤ÇRÇȤβ¼¹ßÉôʬ¤¬±äŤ·¤Æ»°³Ñ·Á¤Ë¸«¤¨¤ë¤Î¤Ï¡¤ ¿´³°Ëì¦æʬ¶Ë¤¬Ãٱ䤹¤ë¤¿¤á¤Ç¤¢¤ë¡¥LVH¤âƱ¤¸¹Í¤¨¤¬ÄÌÍѤ¹¤ë¡¥¶»ÉôͶƳ¤Ç¤ÏSÇȤαƶÁ¤Ç¿ÃͲ¼¤¬¤ê¤Ï µÞ½Ô¤Ë¤Ê¤ë¡¥ GE #135 *II¤Ç¦ÄÇȤΤ褦¤Ë¸«¤¨¤ë¤¬¡¤´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¡¤PAC¤Ë¤è¤ëÊ佼ĴΧ¡¥ ¿ÇÃÇ¡§ST¤ÎÉÑÌ®¤ËPAC¤¬¤¢¤ë¡¥V3-5¤ÎSTE¤ÏAMI¤ÈȽÃǤ¹¤ë¡¥ µ¿Ì䡧PAC¤Ë¤è¤ëHIS¦¶áÊÕ¤ÎÊ佼ĴΧ¤Î¸Æ¤ÓÊý¡© GE #136 ½é´ü¤ÎÁ°ÊÉÃæ³Ö¹¼ºÉ ¿ÇÃÇ¡§QT±äŤò½Ò¤Ù¤Æ¤¤¤ë¤¬¡¤V1-5¤Î¾å¤ËÆ̤ÎST¥»¥°¥á¥ó¥È¤Ë¤Ïµ­½Ò¤µ¤ì¤Æ¤¤¤Ê¤¤¡¥ GE #137 PAC¡¥Â³¤¯QRST¤ÏÀµ¾ïÇÈ·Á¡¥ GE #138 ƶÄä»ß¡¥ GE #139 ¿´¼¼¥Ú¡¼¥·¥ó¥° GE #140 Àµ¾ïƶĴΧ GE #141 ƶÀ­ÉÔÀ°Ì® GE #142 ƶÀ­ÉÑÌ® GE #143 ¥­¥ã¥ê¥Ö¥ì¡¼¥·¥ç¥ó¡¤calibratin pulses. GE #144 ¥Ï¥à¡¤AC interference. GE #145 ÂÎÆ°¡¤Mucle Tremor (Somatic). GE #146 ¿ÍÂÎÆ°Íɤˤè¤ë´ðÀþ°ÜÆ° GE #147 ¥Ú¡¼¥¹¥á¡¼¥«¡¼¤È¤Î¥Õ¥å¡¼¥¸¥ç¥ó GE #148 ¥Ú¡¼¥¹¥á¡¼¥«¡¼»É·ãÉÔÎÉ GE #149 ¥Ú¡¼¥¹¥á¡¼¥«¡¼¥»¥ó¥·¥ó¥°ÉÔÎÉ¡¥ GE #150 ¥Ú¡¼¥¹¥á¡¼¥«¡¼½ÐÎÏÉÔÎÉ¡¥ GE #151 ¿´Ë¼¿´¼¼Ää»ß¡¥ GE #152 AF¤È¿´¼¼¥Ú¡¼¥·¥ó¥° GE #153 ¿´Ë¼¥Ú¡¼¥·¥ó¥° GE #154 ¿´Ë¼¿´¼¼¥Ú¡¼¥·¥ó¥° GE #155 ¿´¼¼ÉÑÇï GE #156 ¿´¼¼¥Õ¥å¡¼¥¸¥ç¥ó¼ý½Ì¡¥ ñ¤Ê¤ë´ü³°¼ý½Ì¤«¤ï¤«¤é¤Ê¤¤¡¥PÇȤ˳¤¤¤Æ¿´¼¼´ü³°¼ý½Ì¤¬¤¢¤ë¤è¤¦¤Ë¤â¸«¤¨¤ë¡¥ GE #157 ƶÄä»ß¤Ë¤è¤ë¿´¼¼À­Ê佼ĴΧ¡¥ GE #158 VF GE #159 ƶÀ­ÉÑÇII, III, aVF¤ÎSTD¡¤ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¡¥short PRI ¿ÇÃÇ¡§Lown-Ganong-Levine Syndrome. GE #160 WPW¡¤V2-4¤Þ¤ÇTÇȵÕž¡¥ ¿ÇÃÇ¡§TÇȵÕž¤ÏWPW¤ÎÉûÅÁƳϩ¤Î±Æ¶Á¤«¡¤ÉÂÍýŪ¤Ê¤â¤Î¤«ÉÔÌÀ¡¥ GE #161 ξ¿´Ë¼ÈîÂ硤LQT¡¤ ¿ÇÃÇ¡§IVCD¤È¤µ¤ì¤Æ¤¤¤ë¤¬¡¤RÇȤÎΩ¾å¤ê¤ÎÉÔϢ³ÅÀ¤ò¼¨¤·¤Æ¤¤¤ë¤Î¤«¡© GE #162 MAT¡¤PRP¡¤RAD ¿ÇÃÇ¡§±¦¼´Êа̡¤PRP¤ÈV6¤ÎSÇȤ«¤éRVH¤ò¿ÇÃǤ·¤Æ¤â¤è¤¤¡¥¿´Çï¿ô120¤Ï°Û¾ï¤Ç¤¢¤ë¡¥ GE #163 R on T¡¤ ¿ÇÃÇ¡§µ­½Ò¤µ¤ì¤Æ¤¤¤Ê¤¤¤¬¡¤MAT¤Ç¤¢¤ê¡¤3ÇïÌܤϦÄÇȤǤ¢¤ë¡¥ GE #164 PVC2Ϣȯ¡¥ GE #165 3Ϣ³PVC¡¥ GE #166 PVC¤Î2ÃÊÌ®¡¥ GE #167 PÇȤ¬¤Ê¤¤¤È¿ÇÃǤ·¤Æ¤¤¤ë¤¬¡¤Æ¶Ä´Î§¤Ç¤¢¤ë¡¥PVC¡¥ GE #168 °ì¸»À­¿´¼¼´ü³°¼ý½Ì GE #169 ¿¸»À­¿´¼¼´ü³°¼ý½Ì GE #171 Nodal µÕ¹ÔÀ­PÇÈ¡¤V3-6¤ÎTÇȵÕž¡¥ ¿ÇÃÇ¡§I¡¤aVL¤ÎSTE¤Ï¦Êɹ¼ºÉ¤Î¤è¤¦¤Ë¸«¤¨¤ë¡¥ GE #172 Ãæ³ÖÁ°ÊÉAMI¡¤ÊèÀÐÍÍÇÈ·Á¡¥ ¿ÇÃÇ¡§V1¤ÎqR¤«¤éRBBB¤ÎAMI¤Ç¤¢¤ë¡¥II¡¤III¤ÎrS¤«¤éLAFB¡¥ GE #173 AF¤Î½ùÌ®¡¤II¡¤III¡¤aVF¤ÎSTE¤ÈI¡¤aVL¤Î¥ß¥é¡¼¤Ë¤è¤ëSTD¡¥ ¿ÇÃÇ¡§junctional escape rhythm. ÀܹçÉôÊ佼ĴΧ¡¥SA arrest. GE #174 WPW, III, aVF¤Î°Û¾ïQÇȤÏWPW¤Î¦ÉûÅÁƳϩ¤ÇȯÀ¸¤·¤Æ¤¤¤ë¡¥¦ÄÇȤϳ¤¯QRS¤ÈÉÔϢ³¤Ç¤¢¤ë¡¥ GE #175 I¤ÏrS¤ÇSTE¡¤II,III,aVF¤ÏSTE¤ÇÈó¾ï¤Ë¾®¤µ¤Êq¡¤V1¤ÏR'¤Ç¶¯¤¤STD¡¤ V2¡ÁV4¤Þ¤Ç¤ÏRSr'¤Ç¶¯¤¤STD¡¤V5¤ÏRS¤ÇSTD¤È¾å¸þ¤­TÇÈ¡¤V6¤Ï R¤ÇSTE¡¥²¼Êɹ¼ºÉ¡¤Â¦Êɹ¼ºÉ¤È¸åÊɹ¼ºÉ¤Ç¤¢¤ë¤¬¡¤¥ß¥é¡¼¤¬¶¯²á¤®¤ë¤¿¤á Á°ÊÉÃæ³Ö¤ÎÆâËì²¼¹¼ºÉ¤òʻȯ¤·¤Æ¤¤¤ë¡¥ GE #176 II,III,aVF¤Î°Û¾ïQÇÈ¡¤V2¡ÁV4¤ÏÊèÀÐÍÍÇÈ·Á¡¤V5¡ÁV6¤ÏQ¤ÈSTE¡¤ ¸Å¤¤¸åÊɤȵÞÀ­¤ÎÁ°ÊɦÊɹ¼ºÉ¡¥ GE #177 II, aVF¤ÎSTE¡¤V2-4¤ÎSTE¤Ç¤¢¤ë¤¬¡¤²¼¤ËÆ̤ÎST¥»¥°¥á¥ó¥È¡¥µÞÀ­Á°Êɹ¼ºÉ¤«¡¥ ¿ÇÃÇ¡§¿´¼ê½Ñ¸å¤Î¿´³°Ëì±ê¡¥ GE #178 V2-4¤Î¶¯ÅÙ¤ÊSTE¤È¾å¤ËÆ̤ÎST¥»¥°¥á¥ó¥È¡¥µÞÀ­Á°Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§²¼Êɤò´Þ¤àµÞÀ­Á°Êɹ¼ºÉ¡¥aV¤ÎSTD¤Ï¥ß¥é¡¼¥¤¥á¡¼¥¸¡¥¿´³°Ëì±ê¤Ç¤Ï¤Ê¤¤¡¥ #177¤Ç¤ÏaVL¤Ç¤âSTE¤Ç¤¢¤ë¡¥ GE #179 PVC3ÃÊÌ®¡¤Trigeminal PVC's. GE #180 4ÇïËè¤ÎPVC¡¥ GE #181 ¿´¼¼¸ÇͭĴΧ¡¥idioventricular rhythm. GE #182 Â¥¿Ê·¿¿´¼¼¸ÇͭĴΧ¡¥accelerated idioventricular rhythm. GE #183 ƶÀ­ÉÑÌ®¡¤º¸Ë¼ÈîÂ硤V-3°Û¾ïQÇÈ¡¤º¸¼´Êа̤Ǥ¢¤ë¤¬¡¤LAFB¤Ç¤Ï¤Ê¤¤¡¥(V6¤ÎSÇȤ¬¤Ê¤¤¤¿¤á)¡¥ ¿´ÉÔÁ´¤Ç¤¢¤ë¤¬¡¤MI¤È¤Ï´Ø·¸¤·¤Ê¤¤¡¥ GE #184 ¿´Çï¤Îjanctonal tachycardia, I, II, III, aVF, V5, V6¤ÎST¾å¾º¤Ï¿´³°Ëì±ê¤Î¤¿¤á¡¥ ¿´³°Ëì±ê¤ÏST¡¤AF, JT¤Ç¤è¤¯È¯À¸¤¹¤ë¡¥ GE #185 Wenckebach 4:3 ¤ÎAV B;ock, µÞÀ­²¼Êɹ¼ºÉ¡¤II, III, aVF¤Î°Û¾ïQÇȤÈST¾å¾º¡¤ V2¤ÎSTD¤È¹âTÇȤϸåÊɹ¼ºÉ¡¥ÉÔÀ°Ì®¤Ï¦ÉûÏ©¤Î²þÁ±¤ÏÌÂÁö¿À·Ð¤Î¶ÛÄ¥Äã²¼¤Ç²þÁ±¤¹¤ë¡¥ GE #186 ´Ö·çÀ­WPW¡¤È¿Å¾TÇȤÏWPW¤Ë¤è¤ë°Û¾ïºÆʬ¶Ë¡¥ GE #187 Àµ¾ï¿´ÅÅ¿Þ¡¥ GE #188 1¡ë˼¼¼¥Ö¥í¥Ã¥¯¡¤I,aVL¤ÎµÕžÂоÎÀ­TÇÈ¡¤aVL¤Ï°Û¾ïQÇÈ¡¤V2,V3¤ÎSTE ¿åÊ¿ST¥»¥°¡¤È¿Å¾TÇÈ¡¤V4¤ÎȿžTÇÈ¡¤V5¤Ï¿åÊ¿ST¤ÇTÇȤϤʤ¤¡¥ V6¤ÏSTD¡¤¿åÊ¿ST¥»¥°¡¤¾å¸þ¤­TÇÈ¡¥ ¿ÇÃÇ¡§Lateral ST and T abnormality.¤È¤Ê¤Ã¤Æ¤¤¤ë¤¬¡¤¹â°Ì¦Êɹ¼ºÉ¤Î½é´ü¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¤Î ½é´ü¤È¸«¤ì¤ÐII¡¤III¡¤aVF¤Î¥ß¥é¡¼STD¤ÏÀâÌÀ½ÐÍè¤ë¡¥ GE #189 PÇȤÏQRS¤Î¸å¡¤II,III,aVF¤Î°Û¾ïQÇȤÈTÇÈȿž¡¤ST¤ÏII¤è¤êIII¤ÎÊý¤¬¹â¤¤¡¥ I¤ÈaVL¤ÏSTD¤Ç¾å¸þ¤­TÇÈ¡¥v1¡ÁV3¤Ï°Û¾ïQÇÈ¡¤¾å¸þ¤­Ä¾ÀþST¥»¥°¡¤TÇȾå¸þ¤­¡¤ V4¡ÁV6¤ÏSTD¡¤¾å¸þ¤­TÇÈ¡¥ ²¼Êɹ¼ºÉ¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¡¤V5-6.I,aVL¦ÊÉ(¥ß¥é¡¼STD)µõ·ì GE #190 II,III,aVF¤¬°Û¾ïQÇȤΤ褦¤Ë¸«¤¨¤ëWPW¡¤ST¥»¥°¤ÈTÇȤÏÀµ¾ï¡¥ GE #191 Ì®Çï120¡¤»Í»è¤È¶»ÉôÄãÅÅ°Ì¡¤PRD¡¤ST¤ÏÁ´¤ÆÀµ¾ï¡¥ Acute pericarditis GE #192 Ì®Çï75¡¤I,aVL¤ÎST²¼¹ßȿž¡¤LVH¡¤LAH¡¤µÞÀ­Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ ¥ï¥ó¥À¥ê¥ó¥° ¥Ú¡¼¥¹¥á¡¼¥«¡¼¤Ë¤è¤ëÉÔÀ°Ì®. ¿ÇÃǤϲ¼Êɹ¼ºÉ¤È¤Ê¤Ã¤Æ¤¤¤ë¤¬¡¤II,III,aVF¤ÎÊѲ½¤Ï¤Ê¤¤¡¥¸í¿Ç¡¥ GE #193 I,aVL¤ÎSTD¤ÈTµÕž¡¤II,III,aVF¤Î°Û¾ïQ¤ÈSTE¡¤V2¡ÁV6¤Î¶¯¤¤STD¤È¾å¸þ¤­T¡¥ ²¼ÊÉ¡¤±¦¼¼¹¼ºÉ¡¥±¦´§Æ°Ì®¤ÎÊĺɤ¬È½¤Ã¤Æ¤¤¤ë¤«¤é±¦¼¼¹¼ºÉ¤Ç¤¢¤ë¡¥ V1¤ÎÊѲ½¤¬¾¯¤Ê¤¯¡¤V2,V3¤ÎSTD¤¬¶¯¤¤¤³¤È¤ËÃí°Õ¤¹¤ë¡¥ GE #194 Poor P wave¤ÎSinus Rhythm. LAFB¡¤V1-3¤ÏPoor R Progression¤Ç¤¢¤ê¡¤MI¤Ç¤Ï¤Ê¤¤¡¥VͶƳ¤Î3ÇïÌܤÏSVT¡¥ GE #195 ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¤Ç¤¢¤ê¡¤¶»ÉôͶƳ¤ÎTÇȤϵÕž¡¥¤³¤ì¤Ï´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¤Ç¤ÎÀµ¾ï¤ÊÊѲ½¤Ç¤¢¤ë¡¥º¸¼¼ÈîÂç¤Ï¤Ê¤¤¡¥ GE #196 ¼´90°Ê¾å¡¤ÇÙÀ­PÇÈ¡¤V1¤ÏrsR'¤Ç¤¢¤ë¤¬¡¤rs¤ÏÈó¾ï¤Ë¾®¤µ¤¤¡¥R'¤Ï¥·¥ã¡¼¥×¤Ç Ä̾ï¤Î±¦µÓ¥Ö¥í¥Ã¥¯¤È°Û¤Ê¤ë¡¥V2¡ÁV6¤Þ¤Ç¤Ï¶¯¤¤Éý¤Î¶¹¤¤SÇÈ¡¥±¦µÓ¥Ö¥í¥Ã¥¯ ¤Ç¤¢¤ì¤ÐS¤ÏÉý¤¬¹­¤¤¤«¤é¡¤¤³¤ÎÅÀ¤«¤é¸«¤Æ¤âRBBB¤È¤Ï°Û¤Ê¤ë¡¥V1¤Ï ±¢À­TÇȤǡ¤V2¤Ïʿó¡¤V3-V6¤ÏÄ̾ï¤ÎTÇÈ¡¥RÇȤÏV3¤¬ºÇ¤â¹â¤¯¡¤ V6¤Ë¹Ô¤¯¤Ë¤·¤¿¤¬¤Ã¤ÆÇȹâ¤Ï¾®¤µ¤¯¤Ê¤ë¡¥ÇÙÀ­PÇȤȱ¦¼¼ÈîÂç¡¥ GE #197 PSVT¡¤TÇȤλϤޤê¤ËµÕ¹ÔÀ­PÇÈ¡¤STD¤¬¸«¤¨¤ë¡¥ GE #198 COPD, Wandering AT, ¶»ÉôͶƳ¤ÏCOPD¤ÎÆÃħ¡¤ cf¡¥BB p.75, fig7.17 GE #199 I,aVL¤ÎSTE¡¤II,III,aVF¤ÎST²¼¹ß¤È2ÁêÀ­TÇÈ¡¤V6¤ÎÊѲ½¤Ï¾¯¤Ê¤¤¡¥ ¹â°Ì¦ÊɤÎAMI¡¥
GE200Ìܼ¡¤ËÌá¤ë¡£
GE #200 ±¦¼´Êа̡¤V1¤ÎR/S>1, ¥¹¥È¥ì¥¤¥óT¡¤RVH¡¥RAA¤Ï¤Ê¤¤¡¥ V4¤¬TR¤ÇÀµ¾ïTÇȤÇV6¤Ë¤Ê¤ë¤¬¡¤V6¤Ç¤âRSÇȤǤ¢¤ë¡¥ GE #201 ƶÀ­ÉÑÌ®¡¤º¸Ë¼ÈîÂ硤II¡¤III¡¤aVF¤Î°Û¾ïQÇÈ¡¤STE¡¤VͶƳ¤è¤êLVH¡¥ ¿ÇÃÇ¡§AS¤Ë¤è¤ëLVH¡¥²¼Êɹ¼ºÉ¤ÏÆɤ߲᤮¡¥¤·¤«¤·I¡¤aVL¤ÎSTD¤ÈTÇÈȿž¤Î¤è¤¦¤Ë¸«¤¨¤ë¡¥ GE #202 1ÅÙAV¥Ö¥í¥Ã¥¯¡¤IVCD¤«´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¡¥V6¤ÏrS·¿¤À¤«¤éIVCD¤À¤í¤¦¡¥ ¿ÇÃÇ¡§LBBB¡¥I¡¤aVL¤ËqÇȤ¬¤Ê¤¤¤«¤é¡¤LBBB¡¥ GE #203 V2-6¤ÎÂоÎÀ­µÕžTÇȤè¤ê¡¤¿´ÆâËì²¼¹¼ºÉ¡¥ ¿ÇÃÇ¡§¿´ÆâËì²¼¹¼ºÉ¡¤ST¥»¥°¥á¥ó¥È¤Î±äĹ¤Ï¤è¤¯¸«¤é¤ì¤ë¡¥QTD¤Ë¤Ê¤ê¡¤¼ý½Ì»þ´Ö¤Î±äŤò°ÕÌ£¤¹¤ë¡¥ GE #204 I,aVL¤ÎST±ú¡¤II,III,aVL¤Ër¤¢¤ê¡¤V1¤ÏQS¡¤V2¡ÁV6¤Ë¤ÏRÇÈ¡¤ »þ·×²óž¡¤¿ÇÃǤˤϵ­½Ò¤µ¤ì¤Æ¤¤¤Ê¤¬LAH¤Ç¤¢¤ë¡¥ GE #205 I,aVL¤ÎSTD±ú¡¤II,III,aVF¤ÎSTEÆÌ¡¤V1,V2¤ÎSTD¤ÈÆÌTÇÈ¡¤V5,V6¤ÎSTE¤ÈÆÌT¡¥ ²¼ÊɸåÊÉAMI¡¥ ¿ÇÃÇ¡§V1,V2¤Î²ò¼á¤¬¤Ê¤¤¡¥¹­ÈϤʹ¼ºÉ¤Ç¤¢¤ê¡¤±¦¼¼¹¼ºÉ¤ò´Þ¤à¤È»×¤ï¤ì¤ë¡¥ GE #206 I,aVL¤ÎSTD¡¤II,III,aVF¤Î°Û¾ïQÇÈ¡¤STE¡¤TµÕž¡¥V1,V2¤Î¹â¤¤TÇÈ¡¥ V2¤ÏSTD¡¤V6¤ÎSTʿó±úTÇÈ¡¥Î¾¿´Ë¼ÈîÂ硤²¼Êɹ¼ºÉ¡¤¸åÊɤ˵ڤ֡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥#213¤Î½ê¸«¤Î¼¡¤ÎÆü¤ÎECG¤È½ñ¤¤¤Æ¤¤¤ë¤¬ÉÔÌÀ¡¥ GE #207 I,aVL¤ÎSTD±ú¡¤II,III,aVF¤Î°Û¾ïQÇȤȿåÊ¿¾®¤µ¤Ê±úT¡¥V1¤ÏSTE¤ÈÆÌT¡¤ V2¤ÏSTD¤ÈÆÌT¡¥V6ST¤Ï¿åÊ¿¡¥¸Å¤¤²¼Êɹ¼ºÉ¡¥ ¿ÇÃÇ¡§V2,V3¤è¤êÁÎ˼PÇÈ¡¤V2¤ÎR¤¬¹â¤¤¡¥È¿»þ·×²óž¡¥¸åÊɹ¼ºÉ¤Ë¤·¤Æ¤ÏV1¤ÎrÇȤ¬Äã²á¤®¤ë¡¥ GE #208 4:1¤ÎAF¡¤PRP¡¤V4-5¤ÎSTD ¿ÇÃÇ¡§¥¸¥®¥¿¥ê¥¹¸ú²Ì¡¥ GE #209 I, aVL¤Îflat TÇÈ¡¤V5-6¤Î±¢À­TÇÈ¡¥ ¿ÇÃÇ¡§Î¾¿´Ë¼ÈîÂ硤º¸¼¼¹âÅÅ°Ì¡¤ GE #210 I, aVL¤ÎSTD¡¥II, III, aVF¤ÎSTE¤è¤êµÞÀ­²¼Êɹ¼ºÉ¡¥ GE #211 Mobitz II¡¤2ÅÙAV ¥Ö¥í¥Ã¥¯¡¥ GE #212 3ÅÙAV ¥Ö¥í¥Ã¥¯¡¥ GE #213 WPW¡¤TÇȵÕž¤ÏWPW¤Ç¤ÎÀµ¾ïÊѲ½¡¥ GE #214 1ÅÙAV ¥Ö¥í¥Ã¥¯¡¥ GE #215 CLBB GE #216 WPW GE #217 1ÅÙAV ¥Ö¥í¥Ã¥¯¡¥ GE #218 Mobitz I (Wenckebach) 2ÅÙAV ¥Ö¥í¥Ã¥¯¡¥ GE #219 Â¥¿Ê·¿AV ÀܹçÉôĴΧ¡¥ GE #220 ÀܹçÉôÉÑÇµÕ¹ÔÀ­PÇÈ¡¥Ãí°Õ¡¥ GE #221 Wandering Pacemaker °ìÈÌŪ¤Ë¿´Çï¿ô¤Ï60°Ê²¼¤Ë¤Ê¤ë¡¥Ãí°Õ¡¥ GE #222 ±¦µÓ¥Ö¥í¥Ã¥¯¡¥ GE #223 ¿´Ë¼ÉÑÇï GE #224 ¿´Ë¼ÁÆÆ°¡¥ GE #225 ¿´Ë¼ºÙÆ°¡¤ÁÆÆ°¤ËÈæ¤Ù¤Æ¿¶Éý¤¬¾®¤µ¤¤¡¥ GE #226 ÀܹçÉôĴΧ¡¥±¦µÓ¥Ö¥í¥Ã¥¯¤ÇSTE¡¥ GE #227 ¿´Ë¼´ü³°¼ý½Ì¡¥ GE #228 ¿´Ë¼´ü³°¼ý½ÌÆóÃÊÌ®¡¥ GE #229 3th Phase ±¦µÓ¥Ö¥í¥Ã¥¯·¿ÊѹÔÅÁƳ¡¥ GE #230 GE #231 GE #232 GE #233 GE #234 II,III,aVF¤Î°Û¾ïQÇÈ¡¤III,aVF¤ÎST²¼¹ß¡¤È¿Å¾T¡¥¸Å¤¤²¼Êɹ¼ºÉ II¤ÎST¤ÏÀµ¾ï¡¥¿ÇÃÇ¡§´û±ýÎò¤ÇMI¤«È½ÃǤ¹¤ë¡¥Àµ¾ïqÇȤ«¤â¤·¤ì¤Ê¤¤¡¥ GE #235 Á°ÊÉÃæ³ÖAMI¡¥III¤ÎQÇȤÀ¤±¤Ç¤Ï²¼Êɹ¼ºÉ¤Î¿ÇÃǤϤǤ­¤Ê¤¤¡¥ GE #236 I,aVL¥¹¥È¥ì¥¤¥óTÇÈ¡¤ÁÎ˹PÇÈ¡¤LVH¡¥ GE #237 LAH, V1¤ÎqR, V6¤ÎRS¤è¤êIRBBB. ¿ÇÃÇ¡§¾åµ­¤ËÄɲä·¤Æ1st AV block, LAH. I,aVL¤Î¹âÅṲ̋Ϻ¸¼¼ÈîÂç¤Î¾ò·ï¤ËŬ±þ¤¹¤ë¡¥ GE #238 ÇÙÀ­P¡¤IÄ㿶Éý¡¤¼´90, »þ·×²óž¡¤Î¾¿´Ë¼ÈîÂ硤ÉÑÌ®¡¤±¦¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§ÇÙµ¤¼ð¤Ç¤¢¤ê¡¤±¦¼¼ÈîÂç¤È¤Ï¸À¤¨¤Ê¤¤¡¥ GE #239 ½ùÌ®¡¤PÇȤʤ·¡¤Af, II,III,aVF¤ÎÂ礭¤ÊQÇÈ¡¤CLBBB. ¿ÇÃÇ¡§IVCD, CLBBB¤Ê¤éV6¤ÏRÇȤ¬É¬Íס¤¤·¤«¤·V5¤ÇrSr', V6¤ÇQS¤Ç¤¢¤ë¡¥ IVCD¤ÏQRSÉý¤¬0.12sec°Ê¾å¡¢V1¤Çº¸µÓ¥Ö¥í¥Ã¥¯·¿(rS)¡¤V6¤Ç±¦µÓ¥Ö¥í¥Ã¥¯·¿(Rs)¤Ç¤¢¤ë»ö¡¥ Af¤ÏNodal¤ÇŬÅö¤Ê¿´Çï¤òÊݾڤ¹¤ë¤¬¡¤½ùÌ®¤Ë¤Ê¤ë¤Èsick AV node¤È¤¤¤¦¡¥ GE #240 CRBBB,LAFB,LVH,LQT GE #241 LAFB, IRBBB, PRP GE #242 WPW GE #243 QRS 0.12, Axis <-60, LAFB, PRP¡¤V1¡ÁV6¤Þ¤ÇrS¥Ñ¥¿¡¼¥ó¡¥IVCD¡¥aVL¤ËqÇȤ¬¸«¤¨¤ë¤«¤éLBBB¤Ç¤Ï¤Ê¤¤¡£ ¿ÇÃÇ¡§Á°ÊÉÃæ³Ö¹¼ºÉ¤Î½é´ü¡¥ GE #244 1¡ëAV block, II, III,aVF¤Î²¼¹ßST¤È¾å¸þ¤­TÇÈ¡¥digitalis¤Ë¤è¤ëËß¾åTÇÈ¡¥ GE #245 ÉÑÌ®¡¤CRBBB¡¤ ¿ÇÃÇ¡§2:1¤Î¿´Ë¼ÁÆÆ°¡¥STD¤ÏÉÑÌ®¤Ë¤è¤ë±Æ¶Á¡¥¿´Ë¼ÁÆÆ°¤Ï¤è¤¯¤ï¤«¤é¤Ê¤¤¡¥ GE #246 AF¤ÈÉÑÌ®¡¥ÉÑÌ®¤Ë¤è¤ëSTD¡¤LVH¡¥ GE #247 NSST-TWC. digitalis¸ú²Ì¡¥ GE #248 axis -30, SN, ¦ÊÉ¡¤¹â°Ì¦Êɵõ·ì¤Ç¤Ï¤Ê¤¯NSSTC¡¤IVCD¤Ç¤¢¤ë¡¥ GE #249 I,aVL¤ËQÇÈSTE¡¤V1¡ÁV6¤Þ¤ÇQS¡¤STE¡¤ST¤Ï¾å¸þ¤­±ú¤Ç¤¢¤ë¡¥Á°Êɹ¼ºÉ¡¤ ·ìÀòÍϲò¸å4»þ´Ö¡¥III, aVF¤Ë¥ß¥é¡¼STD¡¥¿´¼¼áî¤Ç¤Ï¤Ê¤¤¡¥ GE #250 I¤ÈaVL STD¡¥II, III, aVF¤ÎSTE¡¤III¤À¤±QÇÈ¡¤V1¤ÏrR¤ÇSTD±¢À­TÇÈ¡¤V2-3¤ÏRS¤ÇSTD¡¤ÍÛÀ­TÇÈ¡¤ V5-6¤ÎRÇȤϾ®¤µ¤¯¡¤STE¤Ë¸«¤¨¤ë¡¥²¼ÊɸåÊɹ¼ºÉ¡¥ ¿ÇÃÇ¡§²¼Êɹ¼ºÉ¤Ï³Î¤«¡¥V5-6¤ÎSTE¤è¤ê¦Êɹ¼ºÉ¡¥¸åÊɹ¼ºÉ¤Ï¦Êɹ¼ºÉ¤ÎϢ³¤È¸«¤Æ¤â¤è¤¤¡¥ GE #251 normal ECG. GE #252 V1-2¤Î°Û¾ïQÇȤè¤ê¸Å¤¤Ãæ³Ö¹¼ºÉ¡¥ ¿ÇÃÇ¡§²¼ÊÉ¡¤Ãæ³Ö¹¼ºÉ¤Ïµ¿Ìä¡¥I, aVL, V5-6¤ÎʿóTÇȤËÃí°Õ¡¥ GE #253 I, aVL V2-V5¤Þ¤Ç¤Î±¢À­TÇȤè¤ê¿´ÆâËì²¼¹¼ºÉ¡¥ ¿ÇÃÇ¡§non-Q infarction. GE #254 AF, IVCD, LVH. AF¤ÈLVH¤Ï³Î¤«¤Ç¤¢¤ë¡¥CLBBB¤Ç¤Ï¤Ê¤¯IVCD¤ÎÍý¶þ¤Ï¤ï¤«¤é¤Ê¤¤¡¥ GE #255 3¡ëAV Block¡¤CRBBB¡¤½ùÌ®¡¥ ¿ÇÃÇ¡§Ì®Çï30¤Îentricular escae rhythm. CRBBBÍͤǤ¢¤ë¤¬AV NodeĴΧ¤Ç¤Ï¤Ê¤¤¡¥ V1¤òqR·¿¤ÎCRBBB¤È¤¹¤ë¤ÈV2¤ÎrÇÈ¡¤I¡¤aVL¤ÎrÇȤÎÀâÌÀ¤¬¤Ç¤­¤Ê¤¤¡¥ GE #256 GE #257 GE #258 I,aVL¤ÎQÇÈ¡¤STE¡¤PRD¡¤II,III,aVF¤ÎSTD¡¤V1¤ÎrÇȤÏÉÔÌÀQS¤«¤â¡¤V2-6¤Î QS¡¤STD¡¥Á°ÊÉÃæ³Ö¦ÊÉAMI¡¤²¼ÊɤΥߥ顼¡¥ ¿ÇÃÇ¡§AMI¤Ç¤ÏQT-long¤Ë¤Ê¤ê¡¤VT¤¬È¯À¸¤·¤ä¤¹¤¤¡¥ GE #259 PR 0.20, QT-long, V2-6¤ÎSTD¡¤¾å¸þ¤­TÇÈ¡¥ÉÑÌ®¤Ë¤è¤ëÈ¿±þÀ­µõ·ì¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¤PR¤Ï0.24¤È¿ÇÃÇ¡¥ GE #260 ¦ÊɸåÊɹ¼ºÉ¡¥µÞÀ­´ü¡¤I, aVL¤ÎQÇȤÈST¾å¾º¡¥V6¤âQÇȤÈST¾å¾º¡¥ V1-3¤Î¹â¤¤RÇȤÈÂоÎÀ­¹âTÇÈ¡¥ GE #261 AF¡¤V2¤¬¹â¿¶Éý¤Ç¤¢¤ê¡¤LVH GE #262 GE #263 GE #264 Axis -40¡ë¡¤º¸¼´Êа̡¤PRP¡¤LAFB¡¤idiopathic, dilated cardiomyopathy. RÇȤΤߤʤ餺¡¤ SÇȤ⾮¤µ¤¯¤Ê¤ê¡¤V6¤Ç¤ÏÅṲ̋¬Èó¾ï¤Ë¾®¤µ¤¤¡¥ GE #265 GE #266 GE #267 GE #268 GE #269 I,aVL¤ÏSTD,ȿžT¡¤II,III,aVF¤ÏSTE¡¤QÇȤʤ·¡¤V4STDÆÌTÇÈ¡¤V5,V6TÇȵÕž¡¥ IWAMI¡¥ ¿ÇÃÇ¡§V6¤ÏSTE¡¤²¼ÊɦÊɹ¼ºÉ¡¥V4¤ÏI,aVL¤ÈƱÍͤΥߥ顼ÊѲ½¡¥ GE #270 I,aVL¤ÏSTD¡¤¾å¸þ¤­TÇÈ¡¤II,III,aVF¤ÏSTE¡¤V1¡ÁV4¤Þ¤ÇSTD¡¤V4¤¬ºÇ¤â¶¯¤¤¡¥ V6¤ÎSTE¡¥²¼ÊɦÊɸåÊÉAMI¡¥ ¿ÇÃÇ¡¨¤³¤Î²ò¼á¤Ï´Ö°ã¤Ã¤Æ¤¤¤ë¡¥ GE #271 V1,V2¤ËrÇȤϤʤ¤¤¬¡¤Àµ¾ï¡¥ ¿ÇÃÇ¡§ºÆ¸¡¤Î·ë²Ì¡¤V2¤ËrÇȤò³Îǧ¡¤Àµ¾ï¿´ÅÅ¿Þ¡¥ GE #272 Nodal, »Í»è¤ÇTÇȤ¬Ê¿Ã³¡¤V1¤ÇrS¤ÇTÇÈʿó¡¤V2°Ê¹ß¤ÏRÇȤÇÈóÂоξå¸þ¤­ TÇÈ¡¥¶Ëü¤ÊÈ¿»þ·×²óž¡¥¼´¤Ï-30°ÊÆâ¡¥ ¿ÇÃÇ¡§´§ÀÅ̮ƶĴΧ¡¥¶»ÉôͶƳ¤ÎÀâÌÀ¤Ê¤·¡¥ »ä¸«¡§¿´ÆâË즤ȿ´³°Ë즤ÎÇÈ·Á¤¬°ìÃפ¹¤ë¤ÈST¥»¥°¤âTÇȤâʿó¤Ë¤Ê¤ë¡¥ ¶»ÉôͶƳ¤Ç¤ÏV2°Ê¹ß¤Î¾å¸þ¤­ST¤ª¤è¤ÓTÇȤ¬¸º¿ê¤·¤ÆV6¤Ç¥Õ¥é¥Ã¥È¤Ë ¤Ê¤ë¤Î¤ÏǼÆÀ¤Ç¤­¤ë¡¥ GE #273 ¼´20, »Í»è¤ÎSTT¤Ïʿó¡¤V1¡ÁV5¤Þ¤ÇrS¡¤V6¤ÏR¡¥ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¡¥ ¿ÇÃÇ¡§¶»Éô¤Ë´Ø¤¹¤ë¥³¥á¥ó¥È¤Ï¤Ê¤¤¡¥ GE #274 I,aVL¤Çº¸¼¼ÈîÂç¡¥V1,V2¤ÏQS¡¤V6¤ÎRS¤è¤ê»þ·×²óž¡¥ ¿ÇÃÇ¡§º¸¼¼ÈîÂ硤V1,V2¤ÎQS¤ÏÌäÂê¤Ë¤·¤Æ¤¤¤Ê¤¤¡¥V6¤ÎRS¤Î¤¿¤á º¸¼¼ÈîÂç¤Îŵ·¿Åª½ê¸«¤ÏÆÀ¤é¤ì¤Æ¤¤¤Ê¤¤¡¥ GE #275 SN, ½ùÌ®¡¤I,aVL¤ÇSTD¡¤III¤ÏQÇȤÇSTE¡¤V1¡ÁV4¤ÎSTE¤Ç¤¢¤ë¤¬¡¤ST¥»¥°¤Ï ¾å¤Ë±ú¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¤Î½é´ü¤Þ¤¿¤Ï²¼ÊɸåÊɹ¼ºÉ¤Î½é´üÃʳ¬¡¥ ¿ÇÃÇ¡§V5-6¤ÎSTE¤È½Ò¤Ù¤Æ¤¤¤ë¤¬°ÕÌ£¤¬¤ï¤«¤é¤ó¡¥ GE #276 ƶÉÑÌ®¡¤LAH¡¤V1-3¤Þ¤ÇQS¡¤Tȿž¡¤V4-6¤ÇRÇÈÁý¹â¡¤¾å¸þ¤­T¡¥ ¿ÇÃÇ¡§SVT¡¤LAH¡¥ GE #277 V1¡ÁV6¤Þ¤ÇrSÇÈ¡¤¤½¤ÎľÁ°¤Ë¥Ú¡¼¥·¥ó¥°¥Î¥¤¥º¤¬¤¢¤ë¡¥TÇȤÏÁ´¤Æȿž¡¥ º¸µÓ¥Ö¥í¥Ã¥¯·¿¤Î¿´Ë¼¥»¥ó¥¹¡¤±¦¼¼¥Ú¡¼¥·¥ó¥°¡¥ GE #278 I,aVL¤ÏSTDȿžT¡¥II,III,aVF¤ÏSTEÂоÎTÇÈ¡¤V1,V2¤ÎSTD¤È¾å¸þ¤­T¡¥ V5,V6¤Ï¤ä¤äSTD¤ÇÂ礭¤ÊÊѲ½¤Ê¤·¡¥ ¿ÇÃÇ¡§²¼ÊÉAMI. µ­½Ò¤Ë¤Ê¤¤¤¬¡¤±¦¼¼¹¼ºÉ(¸åÊɹ¼ºÉ)¤â¹Í¤¨¤é¤ì¤ë¡¥ final¤Î¥ß¥é¡¼¥¤¥á¡¼¥¸¿Þ22¤ÈƱ¤¸½ê¸«¤Ç¤¢¤ë¡¥ GE #279 GE #280 ÇÙÀ­PÇÈ¡¤±¦¼´ÈîÂç¡¥V1¤ÏrsR·¿¡¤V6¤ÏRS·¿¤Ç V3-6¤Þ¤ÇSÇȤ¬Â礭¤¤¡¥±¦Ë¼±¦¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§»°ÀíÊÛÊĺ¿ÉÔÁ´¤Ë¤è¤ë±¦Ë¼º¸Ë¼±¦¼¼ÈîÂç¡¥º¸Ë¼ÈîÂç¤ÏV1¤ÎȿžTÇÈ¡¥ GE #281 GE #282 GE #283 I,aVLÂоÎÀ­Tȿž¡¥V1-4¤âÂоÎÀ­Tȿž¡¥V5¤ÏÈóÂоÎTȿž¡¥V6¤Ï¿åÊ¿¡¥ ÆðۤʺÆʬ¶Ë¥Ñ¥¿¡¼¥ó¡¥ ¿ÇÃÇ¡§Á°ÊÉÃæ³Ö¤ÎNon-Q MI. ¿´ÆâËì²¼¹¼ºÉ¡¥ GE #284 #43¤ÈƱ¤¸¿´ÅÅ¿Þ¡¥I,II¤Ë¥Ú¡¼¥·¥ó¥°¥¯¥ê¥Ã¥¯¡¥CLBBBÍÍIVCD¡¥ ¿´Ë¼¥Ú¡¼¥·¥ó¥°¡¥¿´Çï100. II,III,aVF¤ÎSTE¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥Ã±¶Ë¿´Ë¼¥Ú¡¼¥·¥ó¥°¡¥ GE #285 GE #286 GE #287 GE #288 GE #289 GE #290 PR 0.2, QRS 0.14, CLBBB, ¿ÇÃÇ¡§ÉÑÌ®¤Ë¤è¤ëCLBBB¤Ç¡¤Ì®ÇïÄã²¼¤¹¤ì¤Ð²þÁ±¤¹¤ë¡¥ GE #291 PR 0.24, PAC¤¬¤¢¤ë¤¬¡¤V1-3¤Ï»þ·×²óžÍͤǤ¢¤ë¡¥TR¤Ï V4-5°Ê³°¤Ë°Û¾ï¤Ê¤·¡¥ ¿ÇÃÇ¡§¾åµ­¤ÈƱ¤¸¡¥isoelectric¤È¤ÏR/SÈ椬1¤ò°ÕÌ£¤¹¤ë¡¥ GE #292 CLBBBÍÍ¥Ú¡¼¥·¥ó¥°¡¥ ¿ÇÃÇ¡§¿´Ë¼¿´¼¼¥Ú¡¼¥·¥ó¥°¡¥ GE #293 SN ½ùÌ®¡¤II,III,aVF¤ÎQSȿžT¡¥V5-6¤ÎQS¤ÈȿžT¡¥»Í»èÄãÅÅ°Ì¡¤²¼ÊɦÊÉMI¡¥ ¿ÇÃÇ¡§¾åµ­¤ËLAD¤òÄɲ᥼´¤Ï¾ï¤Ë¹Í¤¨¤ë¡¥ GE #294 ±¦¼¼¥Ú¡¼¥·¥ó¥°¡¥Åµ·¿Åª¤Êº¸µÓ¥Ö¥í¥Ã¥¯ÇÈ·Á¤Ë¤Ê¤ë¡¥V6¤ÇQS¥Ñ¥¿¡¼¥ó ¿ÇÃÇ¡§¥Ú¡¼¥·¥ó¥°»É·ã¤ÎÁ°¤ËPÇȤ¬¤¢¤ê¡¤P¥»¥ó¥¹V¥Ú¡¼¥·¥ó¥°¡¥ GE #295 LAFB. È¿»þ·×²óž¡¥ ¿ÇÃÇ¡§¥Ü¡¼¥À¡¼¥é¥¤¥ó¤À¤«¤é¿ÇÃǤ·¤Æ¤Ï¤¤¤±¤Ê¤¤¡¥ GE #296 I,aVL¤ÎSTD¡¤II¤ÎQÇȤϾ®¤µ¤¤¤¬III¤ÎQÇȤÏÂ礭¤¤¡¥V5¤ÏSTD¡¤V6¤ÏTȿž¡¥ ¿ÇÃÇ¡§ÉÑÌ®¤ÈII,III,aVF¤ÎȿžT¤ÏAMI¤Ç¤¢¤ë¡¥ GE #297 ƶÀ­½ùÌ®¡¥ ¿ÇÃÇ¡§V2-4¤òTUÇȤÈÆɤࡥ2ÁêÀ­¤Ç¤Ï¤Ê¤¯ÆÌÆÌÇÈ·Á¤Ç¤¢¤ë¤³¤È¤ËÃí°Õ¡¥ GE #298 I,aVL¤è¤êLVH¡¤TR¤ÏV4-5¤À¤«¤éÈ¿»þ·×²óž¡¥V1-2¤ÎQS¤ÏÀµ¾ïÈÏ°Ï¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥¹â¤¤I,aVL¤ÇLVH¡¤V6¤ÇRS¤À¤«¤é»þ·×²óž¡¤PRP¤Ç¤¢¤ë¡¥ ¤½¤Î¤¿¤á¤ËV1,V2¤ÎQSÇÈ·Á¤ÏÁ°Êɹ¼ºÉ¤ÎQÇȤǤϤʤ¤¡¥ I,aVR,aVL,V1,V2¤Ê¤ÉRÇÈñÆÈÇÈ·Á¤Çlate intrinsicoid deflection¤¬¸«¤¨¤ë¡¥ ÉÔ´°Á´º¸µÓ¥Ö¥í¥Ã¥¯¤È¿ÇÃǤ·¤Æ¤â¤è¤¤¡¥ cf 11-10. GE #299 LAD, CRBBB,CRBBB¤Ç¤ÎLVH¤ÏV5¤Þ¤¿¤ÏV6¤ÎR¤ÈV1¤Þ¤¿¤ÏV2¤ÎSÇȤÎÂ礭¤µ¤Ç ȽÃǤ¹¤ë¡¥2ÁêÀ­¤ÎST¤Ë´Ø¤·¤Æ¤Ï¡¤¥¹¥È¥ì¥¤¥óÍͤÎST¥»¥°¥á¥ó¥È¤ÇȽÃÇ¡¥ °ìÈ̤ËRSÇÈ·Á¤Ç¤¢¤ì¤ÐTÇȤˤĤ¤¤Æ¤Ï²¼¾å¤ÎµÕžTÇȤˤʤ롥
GE300Ìܼ¡¤ËÌá¤ë¡£
GE #300 V1¤ÏCRBBBÍÍ¡¤V6¤ÏCRBBBBÍͤˤè¤êIVCD¡¥ ¿ÇÃÇ¡§Àµ³Î¤Ë¤ÏIVCD¤Èµ­½Ò¤·¤Æ¤¤¤Ê¤¤¤¬¡¤ÅŲò¼ÁKÇ»ÅÙ¸¡ººÉ¬ÍפȽҤ٤롥 GE #301 I,aVL¤ÎSTD¤È¥¹¥È¥ì¥¤¥óT¡¥II,III,aVF¤Î¶¯¤¤STE¤è¤ê²¼ÊÉAMI¡¥V1¹â¤¤RS¡¤ V2-3¤ÏRS¤ÇSTD¡¤V6¤Ï¼å¤¤STD¤ÇÀµ¾ïTÇÈ¡¥ ¿ÇÃÇ¡§²¼ÊÉAMI¡¥V1-2¤Î¹â¤¤R¤Îµ­½Ò¤Ê¤·¡¥Â¦Êɤ䱦¼¼¤Î¹¼ºÉ¤Ï¤Ê¤¤¤È¹Í¤¨¤ë¡¥ GE #302 CLBBB. II¤Ï>0¤À¤«¤éLAFB¤Ï¿ÇÃǤǤ­¤Ê¤¤¡¥ ¿ÇÃÇ¡§AMI¤Ç·ìÀòÍϲò¸å¤ÎECG¡¥ GE #303 È¿»þ·×²óž¡¤Àµ¾ï¿´ÅÅ¿Þ¡¥ GE #304 IRBBB, QT±äĹ¡¥ ¿ÇÃÇ¡§¾å¤Ë²Ã¤¨¤ÆNodal¤ÈV1-3¤ÇµÕ¹ÔÀ­P¤¬QRS¤Î¸å¤Ë¸«¤¨¤ë¡¥ GE #305 PQû½Ì¡¤IVCD¤È»×¤Ã¤¿¤¬WPW¤Ç¤¢¤ë¡¥ ¿ÇÃÇ¡§WPW¡¥V4-6¤ÎSÇȤÏÀµ¾ï¤Ç¤¢¤ê¡¤IVCD¤ÏÈÝÄê¤Ç¤­¤ë¡¥ IVCD¤Ç¤ÏRÇȤÎΩ¾å¤ê¡¤Î©¤Á²¼¤¬¤ê¶¦¤Ë¥¹¥é¡¼¤Ë¤Ê¤ë¡¥CLBBB¤Ç¤ÏV6¤ÎSÇȤϤʤ¤¡£ GE #306 LAH, È¿»þ·×²óž¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¤¼´¤Ï-30¤Ç¤¢¤ë¤«¤é¿ÇÃǤϿµ½Å¤Ë¡¥ GE #307 LAH, CRRB, V1-3¤Î¿¼¤¤QÇÈ¡¤Á°ÊÉÃæ³Ö¹¼ºÉ¡¥ ¿ÇÃÇ¡§Á°ÊÉÃæ³Ö¹¼ºÉ¤Ë¤Ä¤¤¤Æ¤Ïµ­½Ò¤Ê¤·¡¥ GE #308 ¥¹¥±¡¼¥ë¥ª¡¼¥Ð¡¼¤ÎCRBBB¡¥TÇȤνª¤ê¤ËµÕ¹ÔÀ­PÇÈ¡¤Æ¶À­ÉÑÌ® ¿ÇÃÇ¡§CRBBB¤Ç¤ÏLVH¤äLAH¤Ï¿ÇÃǤǤ­¤Ê¤¤¤¬¥¹¥±¡¼¥ë¥ª¡¼¥Ð¡¼¤·¤Æ¤¤¤ë¤¿¤á¤Ë LVH¤È»×¤ï¤ì¤ë¡¥ GE #309 ¼´>90¡¤»Í»è¶»ÉôÄãÅÅ°Ì¡¤V1¤ÏqR¡¤V2-4¤ÏqrS, V5-6¤ÏRS¡¥COPD¤Î±¦¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§4:1¤ÎAF¤«nodal¡¤RVH¡¥±¦¼´Êа̤ÈÄãÅṲ̋Ǥʤ±¤ì¤ÐIRBBB¤òÈÝÄê ¤¹¤ë¤³¤È¤¬¤Ç¤­¤Ê¤¤¡¥¶»Éô¤ÎSÇȤÎÉý¤ÏºÙ˦´ÖÅÁƳ¤È¤âÆɤá¤ë¡¥ GE #310 I,aVL¤ÎÇȹâ¤è¤êLVH, IWMI¡¥ ¿ÇÃÇ¡§LAD¤è¤êLAH¤Î¿ÇÃǤò¤¹¤ë¤«¤É¤¦¤«¤ÏÉÔÌÀ¡£ GE #311 Af¤Ë¤è¤ëÉÑÇSTD¤ÏÈ¿±þÀ­¡¥ GE #312 V1-5¤Î°Û¾ïQÇÈ¡¤V2-V6¤ÎSTE¡¥II,aVF¤ÎSTE¡¥Á°ÊÉÃæ³Ö²¼ÊÉAMI¡¥ ¿ÇÃÇ¡§QRS 0.16¤À¤«¤é¥Ö¥í¥Ã¥¯¤¬ÂÅÅö¡¤V1¤ÎRÇȤòÀâÌÀ¤¹¤ë¤¿¤á¤ËCRBBB¡¥ V6¤Þ¤ÇSTE¤À¤«¤é¦ÊÉAMI¡¥V6¤Þ¤ÇSTE¤¬¤¢¤ë¤ÈII¤äaVF¤ÎSTE¤ÏÅöÁ³¤Î·ë²Ì¡¥ V1¤ÏSTD¤ÈȿžTÇȤǤ¢¤ê¡¤AMI¤ÎSTE¤ò¼¨¤µ¤Ê¤¤¡¥CRBBB¤ÇÁ°ÊÉÃæ³ÖAMI¤Ç ¤¢¤ì¤ÐSTE¤Ë¤Ê¤ë¡¥cf ecg 15-13. µÞÀ­¿´¶Ú¹¼ºÉ¤Ç¤ÏËÜÍèTÇÈȿž¤Ç¤âST¾å¾º¤È¾å¸þ¤­TÇȤˤʤ롥 tombstoneÇÈ·Á¡¤GE #331¤ÈƱ¤¸¡¥ GE #313 ¶»ÉôÀµ¾ï¡¤¼´ 20¡¤Àµ¾ïÈÏ°Ï¡¥ GE #314 II,III,aVF¤Î°Û¾ïQÇÈ¡¤»Í»è¤ÎST¤Ï¿åÊ¿¡¤¶»ÉôQRS0.12, V1¤Ï¹â¤¤RÇÈ¡¤ È¿»þ·×²óž¡¤V5-6¤Î°Û¾ïQÇÈ¡¤¸Å¤¤²¼ÊɦÊɹ¼ºÉ¡¤V1¤ÎR¤è¤ê¸åÊɹ¼ºÉ¡¥ ¿ÇÃÇ¡§PR±äĹ¡¤¼´-30, ¸Å¤¤²¼ÊɦÆÀhµ¤¹¼ºÉ¡¥¸åÊɤε­½Ò¤Ê¤·¡¥ GE #315 PR 0.2, III¤Î¤ßQrÇÈ, I,aVL¤Î¹âRÇÈ¡¤¶¯¤¤È¿»þ·×²óž¡¤NSSTWC, º¸¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§V3-5¤ÎST¤Ïsagging. GE #316 I,aVL¿åÊ¿ST¡¤Tȿž¡¤V1-4¤Ï¾å¤ËÆ̤ÎST¡¤Tȿž¡¤V3¤ÏSTE¡¥Á°ÊÉÃæ³ÖAMI¡¥ ¿ÇÃÇ¡§Non-Q MI. GE #317 SNÉÑÌ® PR 0.16, Á´ÂΤËsagging ST¥»¥°¡¤TÇȤÏÌÀ³Î¤Ç¤Ê¤¤¡¥V2-4¤ÏSTD¡¥ ÉÑÌ®¤Ë¤è¤ëµõ·ìÈ¿±þ¡¥ ¿ÇÃÇ¡§¾åµ­¤Ë²Ã¤¨¤ÆV1-2¤Ï°Û¾ïQÇȤÀ¤«¤éÁ°ÊÉÃæ³Ö¹¼ºÉ¤¬¤¢¤ë¡¥ GE #318 ½ùÌ®¡¤CRBBB·¿¤Î¥¨¥¹¥±¡¼¥×¥ê¥º¥à GE #319 normal. GE #320 I,aVL¿åÊ¿ST¡¤TµÕž¡¤II,III,aVF¿åÊ¿ST¡¤V6µÕžT¡¥º¸¼¼ÈîÂç¡¥ ¿ÇÃÇ¡§NSSTWC. GE #321 IWAMI, I,aVL¥ß¥é¡¼¡¤V1-v5¿åÊ¿ST¤ÈÀõ¤¤TÇÈ¡¤V6STE¡¥Â¦ÊɤËMIÇȵڡ¥ ¿ÇÃÇ¡§¥³¥á¥ó¥È¤¬Ê̤ÎECG¤Ç¤¢¤ë¡¥ GE #322 IRBBB,LAH LAH¤ÏPRP¤òȼ¤¦¡¥PRP¤ÏV3-6¤ÎR/SÈæ¤ÎÁý²Ã¤¬¾¯¤Ê¤¤¤³¤È°ÕÌ£¤¹¤ë¡¥ GE #323 #320¤ÈƱ¤¸¡¥ GE #324 CRBBB+LAFB, II,III,aVF¤Ë¤Ï¾®¤µ¤ÊRÇȤ¬Â¸ºß¤¹¤ë¡¥ ¿ÇÃÇ¡§V1-3¤ËrÇȤ¬Ìµ¤¤¤Î¤ÇÁ°ÊÉÃæ³Ö¹¼ºÉ¤òȼ¤Ã¤Æ¤¤¤ë¡¥ qR'·¿¤ÎRBBB¤ÏÁ´¤ÆÁ°ÊÉÃæ³Ö¹¼ºÉ¤«¡© GE #325 II,III,aVF¤ÎSTD¡¤SNÉÑÌ®¡¤º¸Ë¼Éé²Ù¡¤IRBBB¡¤LongQT, V2-V6¾å¸þ¤­TÇÈ¡¥ ¿ÇÃÇ¡§¾å¤Ë²Ã¤¨¤ÆPRû¡¤LGL¾É¸õ·²¡¥PR 0.8¡¥ GE #326 V1-6¤ÎrSÇÈ·Á¡¤PÇȤθºß¡¤QRS¤Î»Ï¤Þ¤ê¤Ë¥¹¥Ñ¥¤¥¯¡¤DDD¥Ú¡¼¥·¥ó¥°ÉÑÌ®¡¥ GE #327 sagging ST, PAC, ¿ÇÃÇ¡§¥¸¥®¥¿¥ê¥¹ÃæÆÇ¡¤ GE #328 SN, V1-4¤Î°Û¾ïQÇȤÈSTE¡¤Á°ÊÉÃæ³ÖAMI¡¥ STE¤Ï¾å¸þ¤­Ä¾ÀþŪ¤Ç¤¢¤ê¡¤µÞÀ­ÊѲ½¤Ç¤Ï¤Ê¤¤¡¥ËýÀ­¤ÎÁ°ÊÉ¿´¼¼áî¡¥ GE #329 V1¤Ç²¼¸þ¤­PÇÈ¡¤rS¾å¸þ¤­T¡¤V2¤ÏrS¤ÇST¾å¾º¡¤V3-6¤Ï°Û¾ïQÇȤÇST¾å¾º¡¥ II,III,aVF¤ÏQR¿åÊ¿ST¥»¥°¡¤¾å¸þ¤­TÇÈ¡¥Á°ÊɦÊÉAMI¡¥ ¿ÇÃÇ¡§¾åµ­¤Ë²Ã¤¨¤Æ²¼ÊɤθŤ¤¹¼ºÉ¡¥V1¤ÎPÇȤè¤êLAA¡¥ AMI¡¤ÊèÀÐÍÍÇÈ·Á GE #330 Wenckebach, V4-6¤Îpoor T. ¿ÇÃÇ¡§II,III,aVF¤ÎQÇÈ¡¤STE¡¤È¿Å¾TÇȤè¤êAMI¡¥ GE #331 tombstone )ÊèÀÐÍÍÇÈ·Á) GE #332 ±¦¼´ÊаÌV1¤ÇqRÇÈ·Á¡¤ÉÔ´°Á´±¦µÓ¥Ö¥í¥Ã¥¯¡¤¼Â¤ÏRVH¤ÇEisemenger's. V6¤Ç¤âSÇȤÏÂ礭¤¤¡¥V1¤ÏrsR'¤Ë¤Ï¤Ê¤Ã¤Æ¤¤¤Ê¤¤¡¥ GE #333 VͶƳ¤ò´Þ¤àÁ´Í¶Æ³¤ÇSTE -> ¿´³°Ëì±ê (¿´Â¡¼ê½Ñ¸å¤Ç¤Ï¾ï¤Ë¸«¤é¤ì¤ë) GE #334 GE #335 GE #336 GE #337 GE #338 GE #339 GE #340 GE #341 GE #342 1ÅÙAV ¥Ö¥í¥Ã¥¯¡¤Æ¶À­½ùÌ®¡¤PVC¡¥LAFB¡¥PRP¡¥ ¿ÇÃÇ¡§PVC¤Î2ÃÊÌ®¡¥ GE #343 V1¤ÏQR'¡¤V6¤ÏRS¤ÇCRRB¡¤V2,V3¤ÏÂ礭¤ÊQR'¤À¤«¤éÁ°ÊÉÃæ³Ö¹¼ºÉ¡¤ ¼´¤¬120¡ë¤è¤êLPFB¡¤II¤ÎPÇȤϲ¼¸þ¤­¡¤Junctional¤Ï0.12°ÊÆâ¤Ë¤Ê¤ë¤«¤é º¸Ë¼Ä´Î§¤Î²ÄǽÀ­¤¬Â礭¤¤¡¥¹¼ºÉ¤Ëȼ¤¦2»Þ¥Ö¥í¥Ã¥¯¤Ç¤¢¤ë¤«¤é peri-infalction block¤Ç¤¢¤ë¡¥ Ä̾ïqR·¿¤ÎRBBB¤Ç¤ÏV2°Ê¹ß¤ÏRÇȤ¬Àè¹Ô¤¹¤ë¤«¤é¹¼ºÉQÇȤǤ¢¤ë¡¥ GE #344 I, aVL¤ÎSTE¡¤III, aVF¤ÎSTE¡¤V3-6¤ÎSTE¡¥Â¦ÊÉ¡¤¾å°Ì¦ÊÉAMI¡¥ ¿ÇÃÇ¡§¾å¤ÈƱ¤¸¡¥¥Á¥ã¡¼¥È¤Î1ÇïÌܤÏPVC¡¥ GE #345 GE #346 GE #347 GE #348 GE #349 GE #350 GE #351 GE #352 GE #353 GE #354 GE #355 GE #356 GE #357 GE #358 GE #359 GE #360 GE #361 I,aVL¤ÎSTD¡¤II,III,aVF¤ÎSTE¡¤V4-V6¤ÎSTE¤È¾å¸þÀ­ST¥»¥°¥á¥ó¥È¡¥ µÞÀ­²¼Êɹ¼ºÉ¡¤I,aVL¤Ï¥ß¥é¡¼¥¤¥á¡¼¥¸¡¥¿ÇÃÇ¥³¥á¥ó¥È¤Ï´Ö°ã¤¤¡¥ GE #362 GE #363 GE #364 GE #365
¤½¤Î¤¿¤á¤ËPurkinje¤ÏºÇ¤âŤ¯Ã¦Ê¬¶Ë¤·¤Æ¤¤¤ë¡¥¤Þ¤¿¡¤TTX¤¬ºîÍѤ·¤Ê¤¤¡¥ ¿´ÉÔÁ´HF¤Ëav1.8¤ÏÂ礭¤¯´ØÍ¿¤¹¤ë¡¥ ¿´ÉÔÁ´¤ÈNav1.8 AF¤ÈNav1.8
K¥Á¥ã¥Í¥ëÌܼ¡¤ËÌá¤ë¡£
Shaker¤È¤Ï°äÅÁ»Ò̾¤Ç¤¢¤ê¡¤¤½¤Î°äÅÁ»Ò¤«¤éºî¤é¤ì¤ë¥¿¥ó¥Ñ¥¯¤òShaker¥Á¥ã¥Í¥ë¤È¤¤¤¦¡¥ Shaker¥Á¥ã¥Í¥ë¤È¤ÏK, Rb, Se¤Ê¤É¤Î¥¢¥ë¥«¥ê¶â°¤òÄ̲᤹¤ë¥¤¥ª¥ó¥Á¥ã¥Í¥ë¤Ç¤¢¤ë¤¬¡¤ ¼ç¤ËK¥Á¥ã¥Í¥ë¤ò¼¨¤¹¡¥4ÎÌÂΤΥݥê¥Ú¥×¥Á¥É¤Ç¤¢¤ë¡¥ ²¼¿Þ¤Î¤è¤¦¤Ëæʬ¶Ë(³«¸ý)¤·¤Æ¤«¤éºÇ¤âÁ᤯Êĸý¤¹¤ë¤Î¤¬Shaker¤Ç¡¤ ºÇÂçÅÅή¤¬ÃÙ¤ì¤ë¤ÈƱ»þ¤ËÊĸý¤âÃÙ¤ì¤ëK¥Á¥ã¥Í¥ë¤¬¤¢¤ë¡¥ IKur¤¬KV1.5¡¤IKr¤¬KV11.1¡¤IKs¤¬KV7.1 (¥¤¥ª¥ó¥Á¥ã¥Í¥ë A to Z p.62¤è¤ê) IKur: ĶµÞ®³èÀ­²½ÃÙ±äÀ°Î®À­K+¥Á¥ã¥Í¥ë IKr: µÞ®³èÀ­²½ÃÙ±äÀ°Î®À­K+¥Á¥ã¥Í¥ë IKs: ´Ë½ù³èÀ­²½ÃÙ±äÀ°Î®À­K+¥Á¥ã¥Í¥ë K+ÅÅή¤À¤«¤é³°¸þ¤­¤Ç¡ÜÊý¸þ¤Ç¤¢¤ë¡¥ Shab¤äShaw¤Ï³«¸ý¤âÃÙ¤¤¤¬¡¤¤Ê¤«¤Ê¤«Êĸý¤·¤Ê¤¤¡¥ ¹¹¤Ë¡¤IKr¤äIKs¤ÏÃÙ¤ì¤ë¡¥ wakaru3.1pdf p.41¤è¤ê¡¥
IKurÌܼ¡¤ËÌá¤ë¡£
IKur¤ÏĶµÞ®³èÀ­²½ÃÙ±äÀ°Î®K¥Á¥ã¥Í¥ë¡§
IKrÌܼ¡¤ËÌá¤ë¡£
IKr¤ÏKV11.1¤ÇÊÌ̾hERG¤Ç¤¢¤ë¡¥wakaru3.1 p.59. IKr¤ÏµÞ®³èÀ­²½ÃÙ±äÀ°Î®K¥Á¥ã¥Í¥ë¡§ æʬ¶Ë¸å¤¹¤°¤µ¤ÞKÅÅή¤¬È¯À¸¤·¡¤ºÆʬ¶Ë¤Ë¸þ¤«¤¦¡¥ ³èÀ­²½¥²¡¼¥È¤¬³«¤¯¤ÈƱ»þ¤ËÉÔ³èÀ­²½¥²¡¼¥È¤â³«¤¯¤¿¤á »É·ã¤¬¶¯²á¤®¤ë¤ÈµÕ¤ËKÅÅή¤¬¾¯¤Ê¤¯¤Ê¤ë(0 V °Ê¾å¤Î¾ì¹ç)¡¥
IKsÌܼ¡¤ËÌá¤ë¡£
IKs¤Ï´Ë½ù³èÀ­²½ÃÙ±äÀ°Î®K¥Á¥ã¥Í¥ë¡§¦Â¥æ¥Ë¥Ã¥È¤ËminK¤¬ÉÕ¤¯¡¥ æʬ¶Ë¸å¤·¤Ð¤é¤¯¤·¤Æ¤«¤éKÅÅή¤¬È¯À¸¤·¡¤ºÆʬ¶Ë¤Ë¸þ¤«¤¦¡¥ KV7.1¤ÏIKs¤Ç¤¢¤ë¡¥¦Â¥æ¥Ë¥Ã¥È¤ËminK¤¬Åº²Ã¤µ¤ì¤ë¤È¡¤¿Þ3-17¤Î¤è¤¦¤Ë ¶¯ÎϤÊÃÙ±äÅÅή¤Ë¤Ê¤ê¡¤ºÆʬ¶Ë¤¬²Äǽ¤Ë¤Ê¤ë¡¥(wakaru3.1 p.57) ÉÑÌ®¤Ë¤Ê¤ë¤ÈKÅÅή¤Î³«¸ý»þ´Ö¤Î¤¿¤á¤ËAPD¤¬Ã»¤¯¤Ê¤ê¡¤ÅԹ礬¤è¤¤¡¥ (ÃßÀѸú²Ì ¥¤¥ª¥ó¥Á¥ã¥Í¥ë Ato Z p.65¤è¤ê) ¤³¤Î¤³¤È¤ÏµÕ¤ËLQT1¤Î¾É¾õ¤Ç¸½¤ì¡¤ÉÑÌ®¤ÇAPD¤¬Ã»½Ì¤·¤Ê¤¤¡¥ minK(KCNE1)¤¬S5-S6´Ö¤Îp¥ë¡¼¥×¤ËÀø¤ê¹þ¤ó¤Ç¤¤¤ë¡¥
IK1Ìܼ¡¤ËÌá¤ë¡£
ÀÅ»ßÅṲ̋òºî¤ëÆâ¸þ¤­À°Î®K¥Á¥ã¥Í¥ë¤Ï¥»¥°¥á¥ó¥ÈS5,S6¤·¤«¤Ê¤¯ ÅÅ°Ì´¶¼õÀ­S4¤¬¤Ê¤¤¡¥S5,S6¤òM1,M2¤È¸Æ¤Ö¡¥ p loop¤ËÁêÅö¤¹¤ë³èÀ­²½¥²¡¼¥È¤Ï¸ºß¤¹¤ë¤¬¡¤PIP2¤Ë¤è¤ê ¾ï¤Ë³«Êü¾õÂ֤Ǥ¢¤ë¡¥¤·¤«¤·¡¤ºÙ˦²õ»à¤Ë¤Ê¤ë¤È¡¤ÂçÎ̤ËÀ¸»º¤µ¤ì¤ë ¥ê¥¾¥ê¥ó»é¼Á¤Ë¤è¤ê¡¤PIP2¤¬¾ÃÌפ·¡¤¤½¤Î·ë²Ì³èÀ­²½¥²¡¼¥È¤Ï Êĺ¿¤¹¤ë¡¥¤½¤Î¤¿¤á¤ËºÙ˦²õ»à¤Ç¤ÏÀÅ»ßÅṲ̋¬¾å¾º¤¹¤ë¡¥ (¿´Â¡¥¤¥ª¥ó¥Á¥ã¥Í¥ë A to Z p.73¤è¤ê) Lysophosphoglycerides¤ÎÉÔÀ°Ì®Í¶È¯ºîÍÑ ¿´¶Úµõ·ì¤ÈK+¥Á¥ã¥Í¥ë
TWAÌܼ¡¤ËÌá¤ë¡£
T-wave alternans¡ÊTWA¡Ë¸òÂØÀ­(¤³¤¦¤¿¤¤¤»¤¤)TÇÈ TÇȤÎÇȹ⡤ÇÈ·Á¤¬°ì²ó»ö¤ËÊѤëÇÈ·Á¤ò¼¨¤¹¡¥ ÉÑÇï»þ¤ËIto¤ÎÉÔ³èÀ­²½¤«¤é¤Î²óÉü¤¬ÃÙ¤¤¤¿¤á¤Ë³èÆ°ÅÅ°Ì»ý³»þ´Ö(APD)¤Ë ÊѲ½¤¬À¸¤¸¤ë¡¥»ý³»þ´Ö¤¬±äŤ¹¤ë¤ÈTÇȤ¬Ä㤯¡¤Ã»½Ì¤¹¤ë¤ÈTÇȤ¬¹â¤¤¡¥ (¥¤¥ª¥ó¥Á¥ã¥Í¥ë A to Z p.62) T-wave alternans¡ÊTWA¡Ë
UÇÈÌܼ¡¤ËÌá¤ë¡£
U wave LITFL UÇȤÎȯÀ¸¸¶°ø¤ÏÉÔÌÀ¤Ç¤¢¤ë¤¬¡¤Purkinje fiber¤ÎÃÙ±äÀ­ºÆʬ¶Ë¡¤ M-cell¤ÎÃÙ±äÀ­ºÆʬ¶Ë¡¤ ¿´¼¼ÊɤÎʪÍýŪ±¿Æ°¤¬¸À¤ï¤ì¤Æ¤¤¤ë¡¥ °Û¾ïUÇȤȤϡ§ °Û¾ï¤Ë¤ª¤ª¤­¤¤UÇÈ (Prominent U waves) >1-2mm ¤Þ¤¿¤Ï¡¡ TÇȤΠ25¡ó¡¡°Û¾ï¤Î¹â¤µ¡¥ ¸¶°ø¡§ ¡¡½ùÌ®¡¤¹âÅÙ¤ÎÄãK·ì¾É ¡¡¤½¤Î¾¡¤ÄãCa·ì¾É¡¤ÄãMg·ì¾É¡¤ÄãÂβ¹¡¤Ç¾°µÐ¶¿Ê¡¤º¸¼¼ÈîÂ硤ÈîÂçÀ­¿´¶Ú¾É ¡¡ÌôºÞÀ­¤Ë¤Ï ¡¡Digoxin, Phenothiazines (thioiazine), ¡¡Ia Äñ¹³ÉÔÀ°Ì®Ìô (quinidine, procainamide), III Äñ¹³ÉÔÀ°Ì®Ìô (sotalol, amiodarone) µÕžUÇÈ (iInverted U waves) ¸¶°ø¡§ ¡¡´§Æ°Ì®¼À´µ¡¤¹â·ì°µ¡¤ÊÛ¼À´µ¡¤ÀèÅ·À­¿´¼À´µ¡¤¿´¶Ú¾É¡¤¹â¹Ã¾õÁ£¾É ¡¡Prinzmetal angina(°Û·Á¶¹¿´¾É) U wave ´§Æ°Ì®¼£ÎÅ uwave.pdf ÄãK·ì¾É¤Ë¤Ê¤ë¤ÈUÇȤ¬½Ð¸½¡¤PR´Ö³Ö¤Ï±äŤ¹¤ë¡¥ Ä̾ï¤ÏÄãK·ì¾É¤ÇUÇȤÏȯÀ¸¤¹¤ë¤¬¡¤¤½¤ì°Ê³°¤ËǾµõ·ì¤ÇȯÀ¸¤¹¤ë¡¥ ·ìÞùK+Ç»ÅÙ¤¬1.4mEq/L¤ËÄã²¼¤·¤¿¸¶È¯À­¥¢¥ë¥É¥¹¥Æ¥í¥ó´µ¼Ô¤Î¿´ÅÅ¿Þ¡¥ Utah ECG Uwave
The U wave is the only remaining enigma of the ECG, and probably not for long. The origin of the U wave is still in question, although most authorities correlate the U wave with electrophysiologic events called "afterdepolarizations" in the ventricles. These afterdepolarizations can be the source of arrhythmias caused by "triggered automaticity" including torsade de pointes. The normal U wave has the same polarity as the T wave and is usually less than one-third the amplitude of the T wave. U waves are usually best seen in the right precordial leads especially V2 and V3. The normal U wave is asymmetric with the ascending limb moving more rapidly than the descending limb (just the opposite of the normal T wave).

Persistent giant U wave inversion with anoxic brain injury
µÞÀ­Ç¾½ý³²¤Ç¤Ï¾å¸þ¤­¤ÎUÇȤ¬È¯À¸¤·¡¤¹â·ì°µ¤Ê¤É¤Î½Û´Ä½ý³²¤Ç¤Ï²¼¸þ¤­¤ÎUÇȤ¬È¯À¸¤¹¤ë¡¥
ËÜÎã¤ÏµÞÀ­Ç¾½ý³²¤Ç¤Î²¼¸þ¤­¤ÎUÇȤÎÎã¤Ç¤¢¤ë¡¥°ß´É¤òÈ´µî¤¹¤ë¤ÈUÇȤϾ䨤¿¡¥
uwave/uw1.png


Giant U waves: an important clinical clue
The patient U wave

Book¤è¤ê°úÍѤ·¤¿UÇȵ­½Ò
Google:
Hypothesis 2: delayed repolarization 

¸¡¿Ç¤ÇÆÀ¤é¤ì¤¿¼«¸³Îã
uwave/uwave1.png

uwave/uwave2.png

uwave/uwave3.png

uwave/uwave4.png



JÇÈÌܼ¡¤ËÌá¤ë¡£
ŬÀÚ¤ÊÎ×¾²Åª¥¢¥×¥í¡¼¥Á¤Ë¤è¤ëJÇȾɸõ·²¤Î¿ÇÃÇ ¿Þ¤«¤é¤âʬ¤«¤ë¤è¤¦¤Ë0.2mV°Ê¾å¤ÎJÅÀ¥Î¥Ã¥Á¤Ï´í¸±¡¥¤µ¤é¤ËST¥»¥°¥á¥ó¥È¤Î ¿åÊ¿Éôʬ¤¬¤Ê¤¯¡¤¤¹¤°¤Ë¾å¾º¤·¤Æ¤¤¤¯ÍͻҤϿ´³°Ë즿´¶Ú¤ÎÁá´üºÆʬ¶Ë¤¬ ¸¶°ø¤Ç¤¢¤êPhase 2¤ÎR on T¤¬È¯À¸¤·°×¤¯¤Ê¤ë¡¥ 35_195.pdf¤è¤ê¡¥JÇȤϥΥåÁÍͤǤ¢¤ë¡¥¤½¤Îľ¸å¤è¤ê¾å¸þÀ­TÇȤˤʤäƤª¤ê¡¤ ¿åÊ¿Éôʬ¤¬¤Ê¤¤¡¥0:00¤Ç¤ÎJÇȤϾ®¤µ¤¤¤¬2:00¤ÏÂ礭¤¯À®Ä¹¤·¤Æ¤¤¤ë¡¥ 3:00¤Ç¤ÏTÇȤνªÎ»»þ¤ËRÇȤ¬È¯À¸¡¤¤½¤ì¤¬R on T¤Ç¤¢¤ê¡¤vf¤Ë°Ü¹Ô¤¹¤ë¡¥ »²¹Í¡§final p.76 Ito¤Ë¤è¤ë²áʬ¶Ë¤¬Brugada 2·¿¤òºî¤ë¡¥
QT±äĹ¾É¸õ·²Ìܼ¡¤ËÌá¤ë¡£
lqt.gif
Áá´üºÆʬ¶Ë¾É¸õ·²Ìܼ¡¤ËÌá¤ë¡£
early repolarization syndrome early1.gif Áá´üºÆʬ¶Ë¾É¸õ·²¤Î12ͶƳ early2.gif Áá´üºÆʬ¶Ë¾É¸õ·²¤ÎR on T
Wellens¾É¸õ·²Ìܼ¡¤ËÌá¤ë¡£
Áá´ü¿ÇÃǤËÀ®¸ù¤·¤¿Wellens¾É¸õ·²¤Î3¾ÉÎã Æü¾ï¿ÇÎŤÇÃΤäƤª¤­¤¿¤¤Tips Rhinehardt J, et al. Electrocardiographic manifestations of Wellens¡Ç syndrome. Am J Emerg Med. 2002;20¡Ê7¡Ë:638-43. ¡¡¢¬Wellens¾É¸õ·²¤Ë¤Ä¤¤¤Æ¤ÎÏÀʸ
BrugadaÌܼ¡¤ËÌá¤ë¡£
Brugada¾É¸õ·²¤ÎȯÀ¸µ¡½ø
ÊèÀÐÍÍÇÈ·ÁÌܼ¡¤ËÌá¤ë¡£
GE #331 (tombstone) IMG_20180625_0002-a.png GE #312 (tombstone) IMG_20180625_0001-a.png
¥Ç¥ë¥¿ÇÈÌܼ¡¤ËÌá¤ë¡£
uwave/delta1.png uwave/delta2.png uwave/delta3.png uwave/delta4.png
¥¤¥ª¥ó¥Á¥ã¥Í¥ëÌܼ¡¤ËÌá¤ë¡£
https://www.ionadventure.com/content.html ÄɲûñÎÁ¥¤¥ª¥ó¥Á¥ã¥Í¥ë Mechanisms of sodium channel inactivation google sodium inactivation bedside cell physiology ¥¤¥ª¥ó¥Á¥ã¥Í¥ë¡¡¥Ç¡¼¥¿¥Ù¡¼¥¹ http://www.guidetopharmacology.org/GRAC/FamilyIntroductionForward?familyId=82 ¡ù ¥¤¥ª¥ó¥Á¥ã¥Í¥ë¤Ï»é¼ÁÆó½ÅËì¤ò´ÓÄ̤¹¤ëË쥿¥ó¥Ñ¥¯¤Ç¡¤Ãæ¤Ë¹¦¤¬³«¤¤¤Æ¤¤¤ë¡¥ ¥¤¥ª¥óÁªÂòÀ­¤Ï¹¦¤ÎÂ礭¤µ¤ÇÄê¤Þ¤ê¡¤k+ < Na+ < Ca++¤Ç¤¢¤ë¡¥¤·¤¿¤¬¤Ã¤Æ¡¤ K¥Á¥ã¥Í¥ë¤Ïk+¥¤¥ª¥ó¤·¤«Ä̲ᤷ¤Ê¤¤¤¬¡¤Na¥Á¥ã¥Í¥ë¤Ï k+¤ÈNa+¥¤¥ª¥ó¤¬Ä̲᤹¤ë¡¥ ºÙ˦³°¤Ë¤ÏË­ÉÙ¤ËNa+¤¬¤¢¤ê¡¤k+¤Ï¾¯¤Ê¤¤¡¥ ¤Þ¤¿¡¤¥Á¥ã¥Í¥ë¸ý¤Ï¡Ý¤ËÂÓÅŤ·¤Æ¤¤¤ë¤¿¤á¡¤ÍÛ¥¤¥ª¥ó¤ËÂФ·¤Æ¾ïµÛ°úÎϤò»ý¤Ä¡¥ ½¾¤Ã¤Æ¡¤Na¥Á¥ã¥Í¥ë¤ÏNa+¤¬Î®Æþ¤·¤ä¤¹¤¤¾õÂ֤ˤ¢¤ë¡¥ ¤³¤ÎÍý¶þ¤ÏCa++¥¤¥ª¥ó¤Ë¤Ä¤¤¤Æ¤âƱÍͤǤ¢¤ê¡¤Ca¥Á¥ã¥Í¥ë³«¸ý»þ¤Ë¤Ï Na+¥¤¥ª¥ó¤âƱ»þ¤ËήÆþ¤¹¤ë¡¥¤³¤ÎNa+¤Ïæʬ¶Ë»þ¤Î¾ã³²¤Ë¤Ï¤Ê¤é¤Ê¤¤¡¥ Na¥Á¥ã¥Í¥ë Heartland p.163 Readers will understand and retain how the heart functions at the ionic-molecular level including: ¡ù The teleology of the ion-kinetic mechanisms of the ionic-molecular microcosm ¡ù How three little ions produce conduction through, and contraction of, the heart ¡ù The simple ionic mechanism of cell-to-cell myocardial conduction ¡ù How ion movement translates into vectors ¡ù The movement of ions that produces EKG recordings ¡ù How the atria contract without backflow into the great veins and pulmonary veins ¡ù Why there are automaticity foci in the large vein ostia of the atria ¡ù The homeostatic necessity of automaticity foci in emergency situations ¡ù A simplified methodology for understanding autonomic function ¡ù How troponin components participate in myocyte contraction and relaxation ¡ù TnC, TnI, and TnT function ¡ù Size of ions matters ¡ù Why ion-kinetic (ion-moving) structures like ion channels are essential to cell function ¡ù How the ion pumps produce the gradients that drive ions through ion channels and ion exchangers ¡ù Evolution of the Na/Ca ATPase pump ¡ù How the Autonomic Nervous System (ANS) controls ion-kinetic structures by phosphorylation and dephosphorylation ¡ù The nature of sympathetic stimuli and parasympathetic inhibition on the ionic-molecular level ¡ù Voltage versus ligand activation of ion channels ¡ù The peculiar Cl- channels and their purpose during the Action Potential ¡ù How ion channels select certain ions ¡ù How Ca++ ions produce myocyte contraction on the ion level ¡ù The function of the CICR ¡ù How the CICR produces effective myocyte contraction and generates an outward Ca++ ion gradient ¡ù The necessity of ryanodine Ca++ channels ¡ù The tandem function of L-type and ryanodine-type Ca++ channels ¡ù How the sarcoplasmic reticulum (SR) functions ¡ù How the SR stores and releases Ca++ ions ¡ù How myocytes employ Ca++ binding proteins ¡ù The ionic-molecular function that initiates and maintains the myocyte power stroke ¡ù Why T tubules are necessary in the myocyte yet absent from Purkinje cells ¡ù Why myocytes need both superficial and deep cisternae ¡ù The ionic-molecular physiology of myocyte relaxation (diastole) following contraction (systole) ¡ù Why both the cell membrane and the sarcoplasmic reticulum need Ca++ ATPase pumps ¡ù The functions of Na/Ca exchangers ¡ù How and why Na/Ca exchanger function is linked to Na+ channel function ¡ù Explanation of why Na/Ca exchanger function fluctuates during the Action Potential ¡ù Although the cell membrane Ca++ATPase pump and the Na/Ca exchanger remove free Ca++ ions from the myocyte, most Ca++ ions go elsewhere ¡ù Why the myocardium acts like a syncytium to conduct with negligible resistance ¡ù Why gap junction terminology is being replaced by the more specific connexon/connexin protein model ¡ù How gradients move ions through connexons ¡ù The exact nature of cell-to-cell conduction ¡ù The fascinating mechanisms of cell-to-cell depolarization ¡ù How ion channel threshold potential perpetuates cell-to-cell conduction ¡ù Homeostatic function of the Na/H pump and its emergency response ¡ù How myocytes, AV node cells, and Purkinje cells depolarize ¡ù How advancing Na+ ion waves produce the vectors of myocardial conduction ¡ù The nature of \u201cfast\u201d and \u201cslow\u201d Na+ currents ¡ù The anatomy, physiology, and kinetics of Na+ channel opening ¡ù Why ion channel flow is described in terms of open probability ¡ù Why ion channel function requires three operational states ¡ù The necessity of closed versus inactivated ion channel status ¡ù The specific peptide loop dynamics of fast and slow inactivation ¡ù Why ion channels have periods of refractoriness and responsiveness ¡ù The clinical importance of ion channel recovery from inactivation ¡ù The ionic-molecular dynamics of repolarization ¡ù How K+ channels repolarize the myocyte to baseline potential ¡ù Methodology of rectification of ion channel currents; how and why ¡ù The repolarizing K+ channels and the K+ channels that maintain baseline potential ¡ù The teleology of the delayed-rectifier K+ channels ¡ù The physiological reason for the extended plateau of the action potential ¡ù IK1 function and baseline potential ¡ù The ion-kinetic structures that participate in the plateau ¡ù The pathophysiology of Long QT (LQT) syndromes ¡ù Autonomic modulation via G protein intermediaries ¡ù How autonomic function affects automaticity ¡ù How autonomic function affects myocardial conduction and contraction ¡ù How the autonomic nervous system (ANS) regulates AV node conduction ¡ù Discovery of the ionic-molecular etiology of Wenckebach conduction ¡ù ANS input via sensor-receptors provides the data for cardiac homeostasis ¡ù How sympathetic and parasympathetic receptors modulate the function of ion-kinetic structures ¡ù How sympathetic and parasympathetic receptors affect each other\u2019s function ¡ù How parasympathetic influence interferes with sympathetic phosphorylation of ion-kinetic structures ¡ù Bouton-bouton parasympathetic inhibition of sympathetic stimulation ¡ù Parasympathetic inhibition of sympathetic ganglia ¡ù G protein participation in phosphorylation and dephosphorylation activity ¡ù Adenosine \u2013 where and why it originates, and how it works ¡ù Phospholamban and Ca++ sequestration in the sarcoplasmic reticulum ¡ù Homeostatic parasympathetic-sympathetic interaction and interdependance ¡ù Wenckebach conduction as vital homeostatic emergency mechanism ¡ù How K+ channel modulation modifies the action potential and affects the heart ¡ù The function of A1 receptors and M2 receptors ¡ù Na/K ATPase pumps produce and maintain of K+ and Na+ gradients ¡ù The AV node as a homeostatic necessity ¡ù Filtering effects of the AV node ¡ù The role of automaticity foci ¡ù Why AV node cells lack Na+ channels, but Na+ ion influx initiates AV node depolarization ¡ù How Ca++ channels select Ca++ ions from a sea of Na+ ions ¡ù Ca++ channel: structural kinetics of activation ¡ù Fast and slow inactivation kinetics of Ca++ channels ¡ù Slow AV node conduction at the ionic-molecular level ¡ù Calmodulin-assisted fast inactivation of Ca++ channels ¡ù Peptide loop slow inactivation of Ca++ channels ¡ù Sympathetic stimulation of ion-kinetic structures of AV node cells and their parasympathetic inhibition ¡ù Parasympathetic IK(ACh) channel activation inhibits AV node conduction ¡ù Purkinje cell conduction and the ventricular conduction system ¡ù Ionic-molecular mechanisms that facilitate rapid conduction through Purkinje cells ¡ù Na+ channel and Na/Ca exchanger participation in Purkinje depolarization ¡ù Refractoriness of Purkinje cells and Mobitz AV block ¡ù How Mobitz block at normal sinus rates or high degree Mobitz block causes dangerous bradycardia ¡ù Purkinje repolarization and K+ channel activity ¡ù The relation between Purkinje depolarization and conduction ¡ù Ionic-molecular explanation of refractoriness of the ventricular conduction system ¡ù LQT3 and Na+ channel function ¡ù Autonomic regulation of the SA node and automaticity foci ¡ù Autonomic sensor-receptors and SA node homeostasis ¡ù The ion-kinetic structures of the P (pacing) cells of the SA node ¡ù Autonomic modulation of P cell pacing ¡ù Sympathetic/parasympathetic modulation of ion-kinetic structures of the SA node ¡ù IK(ACh) channels and parasympathetic inhibition of the sinus pacing rate ¡ù Ion-kinetic structures are responsible for every aspect of cardiac physiology and pathophysiology. ---------------------------------------------------
¥Á¥ã¥Í¥ëÌ©ÅÙÌܼ¡¤ËÌá¤ë¡£
final p.18¤è¤ê final p.136¤è¤ê
¹âCa·ì¾ÉÌܼ¡¤ËÌá¤ë¡£
¹âCa·ì¾É¤Ç¤Ï2Áê¥×¥é¥È¡¼Á꤬û½Ì¤·¡¤ST¤Îû½Ì¡¤QT¤Îû½Ì¡¤UÇÈÁýÂ礬¸«¤é¤ì¤ë¡¥ Ca¥¤¥ª¥óÊäÀµ¸å¡¤16.4mg/dl¤«¤é10.2mg/dl¤Ë¤Ê¤Ã¤¿¡¥¤¢¤Þ¤êÊѲ½¤Ï¤Ê¤¤¡¥
Ìܼ¡¤ËÌá¤ë¡£