心電図自動診断の限界
http://new.jhrs.or.jp/pdf/education/koredakewa02.pdf
を拝読。
心電図を解析するため、資料、ライブラリを収集中。
ソフトウェア（プログラム）、用語、文献などお勧めがありましたら、ご教示くださると幸いです。
医療用ソフトウェア
医用波形記述規約(Medical waveform Format Encoding Rules)
http://www.mfer.org/jp/WhatIsMFER.htm
MFERアプリケーションビューア(WindowsXP, Windows7)
http://www.mfer.org/jp/downloads/Mwave200b.msi
JAVAアプレット
http://www.mfer.org/jp/downloads/Mwave.jar
MFERパーサ
http://www.mfer.org/jp/downloads/MFRanz.msi
検討事項
臨床症状
理学的所見
検査結果
血液検査
下記項目の範囲は精密検査の要不要の判定基準であって症状・病気の判定基準ではない。
ヘモグロビン:hemoglobin(13.5-15.7 g/dl)
尿素窒素:Urea nitrogen(8.0-22.0 mg/dl)
クレアチニン:creatinine(0.60-1.10 mg/dl)
LDLコレステロール:Low-density lipoprotein cholesterol(60-139 mg/dl)
AST(Aspartate transaminase:アスパラギン酸アミノ基転移酵素(13-33 U/I)
ALT:Alanine transaminase:アラニンアミノ基転移酵素(6-30 U/I)
BNP:brain natriuretic peptide:脳性ナトリウム利尿ペプチド( -18.4)
医療機器標準化
心電情報の収集・記録・保存・再生の標準化へ向けて
心電機器・規格委員会
http://new.jhrs.or.jp/pdf/education/shindenjouhou.pdf
MFER早わかり
https://www.google.co.jp/url?http://www.mfer.org/doc/FMFER_presentation_Tamura_2009_11.pdf
ISO 22077-1:2015 Health informatics - Medical waveform format - Part 1: Encoding rules
https://www.iso.org/standard/61871.html
ISO/TS 22077-2:2015
Health informatics - Medical waveform format - Part 2: Electrocardiography
https://www.iso.org/standard/64551.html
ISO/TS 22077-3:2015 Health informatics - Medical waveform format - Part 3: Long term electrocardiography
https://www.iso.org/standard/64552.html
ISO/WD TS 22077-4
Health informatics - Medical waveform format - Part 4: Stress test electrocardiography
https://www.iso.org/standard/69333.html
ISO/AWI TS 22077-5 Health informatics - Medical waveform format - Part 5: Neurophysiological signals
https://www.iso.org/standard/75153.html
IEC TC62(医用電気機器)ロンドン会議報告
https://www.jeita.or.jp/japanese/assets/pdf/letter/vol26/13.pdf
IEC TC62(医用電気機器)
SC62A:医用電気機器の共通事項
SC62B:医用画像装置
SC62C:放射線治療装置、核医学及び放射線量計
SC62D:医用電子機器
IEC 60601-1
IEC 60601-1-X(EMC、ア ラーム、在宅機器、救命医療機器の安全性他)
IEC 60601-2-77(手術用)
IEC 60601-2-78(リハビリ用)
IEC 60601-1-9(境配慮設 計)
IEC 60601-1-12(救命救急医療機器)
低侵襲プラズマ止血機 器 安 全 規 格IEC 60601-2-75
ISO TC210(医療用具の品質管理と関 連する一般事項)
ISO TC215(保健医療情報)
用語
秋山俊雄の心電図講義
http://new.jhrs.or.jp/education/akiyamalecture/
英日
プリンキピア』(原題:Philosophiae naturalis principia mathematica
定量的証拠(qualitative proof
立体角理論(Solid Angle Theory)
起電力electromotive force
ステラジアン: steradian)
ラジアン(radian
単極電極(wick electrode
収縮期(Systole
拡張期(Diastole)
虚血前(Normal)と，虚血 30 分後(Ischemia)
米国衛生研究所 (National Institute of Health)
フラ ミンガム研究(Framingham Study
プラトー
pig: ブタ
スプリットスクリーン
Thioflavin S 液:
蛍光色素(Thiofavin
陽性に変化したこと(pseudonormalization
虚血領域が広がる形状endocardial wedge shape
##略号
ICD
STT 波形
単極電極(WICK)
前胸壁誘導点(Vpre)
心外膜上の誘導点(Vepi)
Beta Blocker Heart Attack Tria( BHAT Study
Myocardial Infarction Research Unit
(MIRU)
r 半径
rt-PA: alteplase
primary coronary intervention:PCI
Cardiac Magnetic Resonance: CMR
microvascular obstruction:MVO
Area under the curve:AUC
PLATO (PLATelet inhibition and patient Outcome
Motion Compensated Micropipette Holde(r MCMH)
部 分的脱分極(partial depolarization
短絡(shunt)
タイロード液(Tyrode’s solution)
Epigast :心窩部，LV :左室
Q波
C(control)
Epi ECG:単極誘導心外膜面心電図
心電図(Epi )
ST
T波
T(Tyrode’s solution)
ST-T 異常
mv: milli volt
mm: milli metol
sec: second
mmHG:
cm:
H20:
WPW 症候群:
TQ:
AC: 交流増幅器 AC-coupled amplifier
DC: 直流増幅器 DC-coupled amplifier
胸壁(CW
JPN: Japan
J: Journal
K:
P点：
QRS 波：
CCU
STEMI 心筋梗塞
IU
MAX: Maximum
MaxSTE
SumSTR
J-WIND 多施設共同研究
ヒト心房利尿ホルモン(ANP
KATP ニコランジル
Motion Compensated Micropipette Holde(r MCMH)
Ca2+
CK
非虚血域(N)
虚血域(Is)
非虚血部位(N)と虚血部位(I)
細胞内抵抗(Ri)
梗塞領域(If)
ロー チェスター大学の心筋梗塞研究所(MIRU)
ST ベクトル強度(ST-VM
MIRU Class I
aVF
I，aVL，V1 〜 V6 誘導
ST 上昇および ST 下降の絶対値の総和(Σ ST-dev)
QTc QT 間 隔
K+
文献
Ⅰ．立体角理論
1 )Einthoven W : Un nouveau galvanometre. Arch Neerl Sc Ex Nat, 1901 ; 6 : 625 ~ 633
2 )Einthoven W : Die galvanometrische Registerung des men-schlichen Elektrokardiogram : Zugleich eine Beurtheilung der
Anwendung des Capillar-Elektrometers in der Physi-ologie. Pflügers Arch ges Physiol 1903 ; 99 : 472~480
3 )Tawara S : Das Reizleitungssystem des Saugetierherzens. Verlag von Gustav Fischer, Jena, 1906
4 )Suma K : Sunao Tawara : a father of modern cardiology. Pacing Clin Electrophysiol, 2001 ; 24 : 88 ~ 96
5 )Mason JW, Ramseth DJ, Chanter DO, Moon TE, Goodman DB, Mendzelevski B : Electrocardiographic reference ranges
derived from 79,743 ambulatory subjects. J Electrocardiol, 2007 ; 40 : 228 ~ 234
6 )Bazett HC : An analysis of the time-relations of electrocardiograms. Heart, 1920 ; 7 : 353 ~ 370
7 )Newton I : Principia Mathematica Philosophiae Naturalis. Royal Society, 1687 ; 7 : 1713 and 1726
8 )Gauss CF : Carl Friedrich Gauss' Werke. Vol XI, Royal. Society of Sciences. Goettingen, Berlin, Julius Springer, 1924 ;
pp148 ~ pp150
9 )Maxwell JC : A Treatise on Electricity and Magnetism, 2nd, edition, vol II. Oxford, Clarendon Press. 1881 ; pp 31 ~ pp39
10)Bayley RH, Berry PM : The arbitrary electromotive double layer in the eccentric "heart" of the nonhomogenous circular lamina. IEEE Trans Biomed Eng, 1964 ; 11 : 137~147
11 )Bayley RH : Biophysical Principles of Electrocardiography.Med. Book Department of Harper&Brothers, New York, 1958
12 )Holland RP, Brooks H : Precordial and epicardial surface potentials during Myocardial ischemia in the pig. A theoretical and
experimental analysis of the TQ and ST segments. Circ Res, 1975 ; 37 : 471 ~ 480
13)Holland RP, Brooks H, Lidl B : Spatial and nonspatial influences on the TQ-ST segment deflection of ischemia. Theoretical
and experimental analysis in the pig. J Clin Invest, 1977 ; 60 : 197 ~ 214
14)Richeson JF, Akiyama T, Schenk E : A solid angle analysis of the epicardial ischemic TQ-ST deflection in the pig. A
theoretical and experimental study. Circ Res, 1978 ; 43 : 879~888
15)Akiyama T, Serrino P : Separation of the total TQ-ST deflection into its component TQ and ST deflections using a mobile
epicardial wick electrode in porcine myocardial ischemia. J Electrocardiol, 1978 ; 11 : 227 ~ 231
16)Akiyama T, Richeson JF, Ingram JT, Oravec J : Effects of varying the electrical conductivity of the medium between the heart and the body surface on the epicardial and praecordial electrocardiogram in the pig. Cardiovasc Res, 1978 ; 12 :
697 ~ 702
17 )Akiyama T, Serrino P : Intracellular recording from beating heart in situ using a special micropipette holder. Am J Physiol,
1979 ; 237 : H392~H394
18)Akiyama T : Intracellular recording of in situ ventricular cells during ventricular fibrillation. Am J Physiol, 1981 ; 240 :
H465 ~ H471
立体角理論とST-T波異常
1 )Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J Jr, Braunwald E : Factors influencing infarct size following experimental coronary artery occlusions. Circulation, 1971 ; 43 : 67~82
2 )Maroko PR, Libby P, Bloor CM, Sobel BE, Braunwald E:Reduction by hyaluronidase of myocardial necrosis following coronary artery occlusion. Circulation, 1972 ; 46 : 430~437
3 )Braunwald E, Maroko PR:The reduction of infarct size--an idea whose time(for testing)has come. Circulation, 1974 ; 50 : 206 ~ 209
4 )Holland RP, Brooks H : Precordial and epicardial surface potentials during Myocardial ischemia in the pig. A theoretical and experimental analysis of the TQ and ST segments. Circulation Research, 1975 ; 37 : 471 ~ 480
5 )Holland RP, Brooks H, Lidl B : Spatial and nonspatial influences on the TG-ST segment deflection of ischemia. Theoretical and experimental analysis in the pig. J Clin Invest, 1977 ; 60 : 197 ~ 214
JPN. J. ELECTROCARDIOLOGY Vol. 30 No. 4 2010 323
6 )Richeson JF, Akiyama T, Schenk E : A solid angle analysis of the epicardial ischemic TQ-ST deflection in the pig. A theoretical and experimental study. Circ Res, 1978 ; 43 : 879~888
7 )Rigo P, Murray M, Taylor DR, Weisfeldt ML, Strauss HW, Pitt B : Hemodynamic and prognostic findings in patients with transmural and nontransmural infarction. Circulation, 1975 ; 51 : 1064~1070
8 )Moon JC, De Arenaza DP, Elkington AG, Taneja AK, John AS, Wang D, Janardhanan R, Senior R, Lahiri A, Poole-Wilson PA, Pennell DJ : The pathologic basis of Q-wave and non-Q-wave myocardial infarction : a cardiovascular magnetic resonance study. J Am Coll Cardiol, 2004 ; 44 : 554~560
9 )Surawicz B, Knilans TK : Chapter 8. Myocardial Infarction and Electrocardiographic Patterns Simulating Myocardial Infarction. Chou’s Electrocardiography in Clinical Practice, 6th Edition, Elsevier-Saunders, Philadelphia, 2008 ; 162~204
10)Antman EM, Braunwald E : Chapter 50. ST-Elevation Myocardial Infarction : Pathology, Pathophysiology, and Clinical Features. Braunwald’s Heart Disease(Edited by Libby P, Bonow RO, Mann OL, Zipes DP), 8th edition. Saundrs Elsevier, Philadelphia, 2008 ; 1210~1227
11)Cannon CP, Braunwald E : Chapter 53. Unstable Angina and Non-ST Elevation Myocardial Infarction. Braunwald’s Heart Disease(Edited by Libby P, Bonow RO, Mann OL, Zipes DP), 8th edition. Saundrs Elsevier, Philadelphia, 2008 ; 1322
ST 上昇・T 波増高による心機能 評価と予後の予測
参考資料(reference)
J-ABについて
http://j-ab.ncvc.go.jp/?page_id=8
全国合計 心房細動の治療実績
https://caloo.jp/dpc/disease/891
心筋焼灼術 ソニー生命保険株式会社
https://cs.sonylife.co.jp/lpv/pcms/sca/ct/medical/ranking-mi/03.html?lpk=
文書履歴(document history)
ver. 0.10 初稿 20181126