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1 Einthoven triangle P P His
2 4.4 R q s J T avr VR avr avr, avl, avf P QRS ST segment () ( ) K K Ca Ca
3 1 Einthoven Einthoven Einthoven Q Q Einthoven 24 3
4 A. D. Waller Wallerian degeneration A. V. Waller 1887 [1] [2, 3] Waller Willem Einthoven [4] Einthoven [5] I, II, III Einthoven Einthoven 2.2 Einthoven triangle Einthoven 1913 Einthoven triangle [6] potential difference Einthoven Einthoven triangle 2.3 Einthoven Frank N. Wilson Wilson Wilson V R, V L, V F Einthoven Wilson
5 [7] D. B. Geselowitz [8] (source) (sink) sink source Einthoven Wilson [7] [9, 10] 20 [11, 12, 13] [11] source sink 5
6 2.5 Einthoven 19 [14] 6
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7 3 3.1 Einthoven I Einthoven I II III 3.2 Ringer I I Ringer Ringer I Ringer Ringer 7
8 3.4 I 1: S 1, S 2, S 3 R L V ( ) () Na + Ca 2+ K + K + 8
9 ( ) 1 R L I I Ringer 9
10 I 3.8 I I Ringer 3.11 I 1 L I 10
11 2: 3.13 I 3.8, 3.9 I 3.14 I
12 4 4.1 P I II P Einthoven triangle V 1 P P *1 I II III V 1 P 4.2 P I P ( ) I 1, I 2, I 3 I 1, I 2, I 3 I 1, I 2, I 3 P I 1 P I 3 *2 P I 1 I 3 I 2 *1 *2 His 12
13 4.3 His P QRS plateau, His His plateau His His 4.4 R I II R R His I II Purkinje Purkinje I II 4.5 q I q q I Einthoven 13
14 I 4.6 s II s s s Purkinje 4.7 J II QRS ST junction J T II T Purkinje Purkinje T Purkinje Purkinje 14
15 T 4.9 avr VR avr VR avr VR 1.5 ϕ l, ϕ r, ϕ f av R = ϕ r ϕ l + ϕ f 2 (1) V R = ϕ r ϕ l + ϕ r + ϕ f 3 = 2 3 ϕ r ϕ l + ϕ f 3 3 V R = av R (3) 2 (2) 4.10 avr avr avr VR VR VR 4.11 avr, avl, avf P avr, avl, avf P avl avf avl avr avf P 15
16 avr P avl, avf P 4.12 V 1 V 6 avr, avl, avf 4.13 QRS V 1 QRS V 5 QRS 4.12 V 1 V 5 QRS V 1 V 1 V 5 QRS V 1 V ST segment S T ST segment T T J Purkinje Purkinje 16
17 5 ABC 2 10 ( ) 5.1 P V 1 P P V 1 P P P 5.2 QRS qrs I V 5, V 6 R S I V 5, V 6 R T QRS Purkinje plateau Purkinje Purkinje T QRS Purkinje 17
18 Purkinje his Purkinje QRS I V 6 R qrs QRS 60 ms I V 6 R QRS 100 ms I V 6 S V 1 R R S Purkinje QRS 60 ms I V 6 Q R 100 ms I V 6 R V 1 S QRS I q V 1 R Purkinje Purkinje QRS Purkinje 18
19 QRS S I I R I R S 5.4 QRS QRS Purkinje QRS Purkinje Purkinje 5.5 ST Q ST (ST-Elevated Myocardial Infarction; STEMI) R, ST, T 0 R ST segment T ST 19
20 Q R 1/4 Q 0 Q Q ST Q T T ST ST T ST T 5.6 ST T P T P 0 ST segment ST 5.7 () ST ATP K + β ATP 20
21 ST 5.8 ( ) ST Na + -K + ATPase ST ST PQ T ST Q PQ T ABC 5.13 K + K + Na + -K + -ATPase K + K + K + K + K + Na + K + 21
22 K + Na + * 3 ABC ST QT T * 4 PQ 3 QT Purkinje ( p.38) Purkinje T T T *3 K + K + *4 20mM 22
23 5.14 K + Purkinje Purkinje T 2 plateau Na + /Ca Na + /Ca 2+ Na + /Ca 2+ Purkinje T U T U 5.15 Ca 2+ Ca 2+ Na + /Ca 2+ Na + Ca 2+ Ca 2+ 2 Ca 2+ 2 ST segment QT 5.16 Ca 2+ Ca 2+ 23
24 [1] Waller, A. D., Reid., E. W., On the Action of the Excited Mammalian Heart, Philosophical Transactions of the Royal Society of London. B, 178, (1887). [2] Waller, A. D., A Demonstration on Man of Electromotive Changes Accompanying the Heart s Beat, Journal of Physiology, 8, (1887). [3] Waller, A. D., On the Electromotive Changes Connected with the Beat of the Mammalian Heart, and of the Human Heart in Particular, Philosophical Transactions of the Royal Society of London. B, 180, (1889). [4] Kligfield, P., Derivation of the Correct Waveform of the Human Electrocardiogram by Willem Einthoven, , Cardiology Journal, 17, (2010). [5],,, 1, (1935). [6] Einthoven, W., Fahr, G., de Waart, A., On the Direction and Manifest size of the Variations of Potential in the Human Heart and on the Influence of the Position of the heart on the form of the electrocardiogram, American Heart Journal, 40, (1950). (Translated into English) [7] Wilson, F. N., Johnston, F. D., Rosenbaum, F. F., et al., On Einthoven s Triangle, the Theory of Unipolar Electrocardiographic Leads, and the Interpretation of the Precordial Electrocardiogram, American Heart Journal, 32, (1946). [8] Geselowitz, D. B., Dipole Theory in Electrocardiography, The American Journal of Cardiology, 14, (1964). [9],,, 10, (1944). [10],,, 10, (1944). [11], ( ),, 2, (1945). [12], ( ),, 2, (1945). [13], ( ),, 2, (1945). [14], Einthoven,, 10, (1944). [15] ABC 2 ( ) [16] 10 ( ) [17] ( )
基礎心電図学 永久の謎スフィンクス に挑む 名古屋大学医学部医学科四年生 心電図の原理は今なお明らかではなく 教科書の説明は ごまかしにすぎない この謎を解くのは 我々の使命である 心電図とは何か 心電図学の歴史 正常心電図の検討 川口 真一
名古屋大学医学部医学科四年生 心電図の原理は今なお明らかではなく 教科書の説明は ごまかしにすぎない この謎を解くのは 我々の使命である 心電図とは何か 心電図学の歴史 正常心電図の検討 川口 真一 自己紹介 名古屋大学医学部医学科四年生 川口 真一 1982年11月8日生まれ (30歳) 2006年 京都大学工学部物理工学科 卒業 2008年 京都大学大学院エネルギー科学研究科修士課程 修了 2011年
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国試過去問集.PDF
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