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Kokyu to Junkan Volume 31, Issue 8 （August 1983）

呼吸と循環 31巻8号（1983年8月発行）

Japanese English

症例

2度房室ブロック例における運動負荷心電図の有用性 Evaluation of exercise test in patients with second degree atrioventricular block 待井一男 ¹ , 大和田憲司 ² , 小野和男 ² , 束原康文 ² , 木島幹博 ² , 宮崎吉弘 ² , 粟野直行 ² , 佐藤信 ² , 竹沢将俊 ² , 刈米重夫 ² Kazuo Machii ¹ , Kenji Owada ² , Kazuo Ono ² , Yasunori Tsukahara ² , Mikihiro Kijima ² , Yoshihiro Miyazaki ² , Naoyuki Awano ² , Makoto Sato ² , Masatoshi Takezawa ² , Shigeo Kariyone ² ¹太田綜合病院循環器科 ²福島県立医科大学第1内科 ¹Department of Cardiology Ohta General Hospital ²The First Department of Internal Medicine Fukushima Medical College pp.881-888

発行日 1983年8月15日 Published Date 1983/8/15

DOI https://doi.org/10.11477/mf.1404204283

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Abstract 文献概要
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　第一度房室ブロックは臨床上，虚血性心疾患，心筋炎，先天性心疾患を有する場合や，抗不整脈剤使用時，心臓外科手術後などにしばしばみられることがある。それにひきかえ2度房室ブロックは1度房室ブロックより頻度が少なく，多くは器質的心疾患を伴う例や，ジギタリス中毒の際に見られることが多い^1）。こうした房室ブロックは正常人でもみられるが，一般の人に比較して，若い運動選手や活発な中年の人によくみられる^2〜6）。

　それ故房室ブロックの存在だけからは病的とは言えず病的かどうかの判定には，非観血的な方法として，休位変換^7〜8）や運動および薬物負荷試験^3,9,10），が利用されている。最近では観血的な方法として，ヒス束心電図（以下HBE）検査を行って，房室伝導障害の部位診断もなされるようになった^11）。

Second degree A-V block is usually observed in patients with organic heart diseases. However it is also often found in normal subjects especially in young athletics or physically active middle aged persons. Responses to A-V conduction due to changing posture, exercise and administration of atropine sulfate were used to evaluate the atrioventricular disturbed function in order to clarify whether it is due to organic disturbance or functional one. Function of A-V conduction is evaluated by means of Master's step test and ambulatory ECG. Thirteen males and 6 females, 12 to 75 years old patients with second degree AV block on the routine ECG were studied. Second AV block consisted of 17 cases of Mobitz type I and 2 cases of Mobitz type II. In 12 cases out of 19 cases 24 hours electrocardiographic recordings were performed. The following results were obtained.

1. In 16 cases (84.2%) out of 19 cases second degree AV block disappeared and in 2 case (10.5%) second degree AV block was unchanged just after Master's two step test. In one case (5.3%) out of 19 cases Mobitz type I block advanced to Mobitz type II block. On a 15 years old school boy whose second AV block was unchanged by Master's double two step test exercise test by Ergometer was performed, by which the second degree AV block was disappeared.

2. In the cases whose second degree A-V block disappeared by exercise test, the block was observed mainly at night when their heart rate decreased less than day time by ambulatory ECG. From these findings it is suggested that A-V conduction disturbance may occur without any organic changes. On the other hand in a case whose Mobitz type I block was advanced to Mobitz type II, second degree AV block was oberved more frequently at day time during work than at night by ambularory ECG.

3. In 2 out of 19 cases in which second degree AV block was neither recovered nor advanced to Mobitz type II block organic AV conduction disturbance was found. Master's step test is a very simple and usefull method in order to evaluate atrioventricular function whether it is organic or not.