[Experience with the Holter monitoring in ischemic heart disease].
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Biomedical subjects
Publications and source records attributed to M Strommer.
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A case of WPW syndrome associated with recurrent attacks of paroxysmal tachycardia for 25 years, is reported. Vectorcardiograms recorded after an attack offered evidence of multiple anomalous pathways between the left atrium and the left ventricle. The high sensibility of the angle recording channels of the triaxicardiometer, i. e. the polar vectors, is considered to represent a factor essential in delta wave analysis.
In 37 cases of WPW-syndrome the delta and the 10 msec instantaneous vectors of the QRS and the ST and T vectors were determined by a triaxicardiometer (TMC) analogue computer. The Descartes' coordinates were calculated from the polarcoordinates by the application of circular functions and the 12 conventional leads were numerically and graphically reconstructed from them by coeffificients. In the case of WPW-syndrome the chambers are activated partly by the ventricular pre-excitation, partly by the normally generated and conducted impulse. The delta vector is formed by the pre-excitation, it is oriented toward the right posterior superior, the right posterior inferior and the right anterior superior spatial octants. The early ventricular depolarization is spreading on a myogenic way, when reaching the conduction system, it is partially activated. Related to the ventricular pre-excitation the normally generated and conducted impulses have a delay. This "phasic aberrant conduction" is the cause of a "fusion beat" or functional block. If the pre-excitation, spreading on myogenic way reaches one fascicle, a bifascicular block-like WPW-syndrome is resulted. If the early ventricular excitation penetrates two fascicles, a monofascicular block-like WPW-syndrome is developed. If the early excitation of the three fascicles or of the bundle of His takes place by the activation of the James bundle, delta-wave is not generated, the ventricular depolarization remains normal (LGL-syndrome), but in such a case the normally conducted sinus impulses are also delayed.
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The Frank's ECG leads and the polar vectors have been quantified in 165 normal and abnormal cases. The abnormal cases were: postero-diaphragmatical infarctions, left anterior hemiblocks, postero-diaphragmatical infarctions and left anterior hemiblocks together. Our examinations were made with triaxicardiometer (TCM) analogue computer. We formed the numerical averages of the patients' groups into graphical algorithms. According to our examinated abnormal groups the X and the Y ECG derivations and the elevation angles (V degrees) of the polar vectors (triaxicardiograms) have the greatest diagnostical values.
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A series of analogue and digital derivations from recorded electrocardiograms is analysed. Processing such data by digital computer allows the maximum amount of information to be extracted from the data. The triaxicardiometric method enables the differentiation between normal and abnormal cardiograms to be improved by the extra amount of information available. The analyses of 550 patients are presented.