心電図, 冠循環に対する交感神経刺戟及び同作働物質の効果に関する実験的研究(冠動脈導管法による)

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  • Experimental Studies with Coronary Artery Catheterization on the Effects of the Sympathetic Nerve Stimulation and Symphathomimetic Substances upon Electrocardiogram and Coronary Circulation.
  • シンデンズ , カン ジュンカン ニ タイスル コウカン シンケイ シゲキ オヨビ ドウ サドウ ブッシツ ノ コウカ ニ カンスル ジッケンテキ ケンキュウ カンドウミャク ドウカンホウ ニ ヨル

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Part 1 The Effects of The Sympathetic Nerve Stimulation.It has been reported by Maekawa, at the Symposium on "Angina pectoris", the 20th Annual Meeting of Japanese Circulation Society in 1956, that the angina pectoris vasomotorica which is universally accepted to be a functional coronary insufficiency could be caused neurogenically, and its mechanism may be sympathetic in origin. The diagnosis of such neurogenic angina pectoris depends clinically only on the observable change in electrocardiographic pattern i. e., the depression of ST segments and T waves. Do such changes of electrocardiographic pattern indicate a lack of oxygen in the myocardium due to the contraction of the coronary arteries, or a relative lack of oxygen in the myocardium due to increased cardiac work in spite of the dilatation of the coronary artery by the sympathetic nerve excitement ? In order to probe this problem, the author has performed experiments on dogs whose ganglion stellatum and subclavian loop were stimulated electrically. Electrocardiogram, blood pressure and coronary blood flow etc. were recorded simultaneously to study their changes ; thus it was aimed to clarify the patho-physiology responsible for the appearance of the electrocardiographic pattern of coronary insufficiency.Method Normal dogs ranging in weight from 10 to 15 kg. were used. Cononary blood flow was measured by means of catheterization of the coronary artery with the Cournand's catheter which was inserted into the left coronary artery via the left carotid artery. The coronary artery was perfused under the constant pressure with the reserved blood and the amount of the perfused blood was measured with and electromagnetic flowmeter.Electrocardiograms were recorded with the right chest lead, left chest lead and esophageal lead. Arterial pressure was measured in the left femoral artery by means of an electromanometer. The diagram of experimental arrangements is shown in Fig. 1.Conclusion 1) Sympathetic nerve stimulation resulted always in an elevation of blood pressure and an increase of pules rate. (Fig. 14, 15)2) Sympathetic nerve stimulation tended to decrease coronary blood flow at the initial stage and increase it at later stage. (Fig. 13) For example, the directional change in coronary blood flow immediately after the stimulation was : increase in 4, no change in 7 and a decrease in 5 cases. One minute after the cessation, the observed change was : increase in 9, no change in 4 and a decrease in 3 cases. However, since the influence of the heart contractility and pulse rate etc. can not be excluded from the observed effect, it is not certain whether or not the observed results indicate true behaviors of the coronary artery.3) Sympathetic nerve stimulation caused electrocardiographic changes in ST and T. The produced pattern consisted mainly of ST depression and T inversion, but sometimes of ST elevation and an increased amplitude of T waves. (Table 1)4) The coronary insufficiency pattern of the electrocardiogram which appeared after the sympathetic nerve stimulation was not caused by the change in the coronary blood flow of cardiac work. This would suggest that the sympathetic stimulation exerts a direct action on the myocardium.Part 2 The Effects of The Sympathomimetic substances.Although there have been many studies regarding the actions of epinephrine and norepinephrine, which are sympathomimetic substances, on the coronary vessels, there is still no definitive interpretation about their effect, for there are two defferent theories ; the one insists that the coronary vessels are contracted by epinephrine or norepinephrine and the other insists that the coronary vessels are dilated. [the rest omitted]

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