Abstract
1) Avariant of Grishman's method of vectorcardiogram was proposed. When the horizontal plane electrodes were raised to the fifth intercostal space and the distortion of QRS and T loop were cornpared to the original method, findings were obtained which were of considerable theoretical interest and practical clinical value.
2) By raising the electrodes, in normal heart the QRS loop displacement was to the left and a concordant shift was seen in the T loop. The QRS-T angle was therefore not enlarged.
3) Compete right bundle branch block showed constant findings in spatial position in the terminal appendage. These findings were divided into type 1 where a large terminal appendage was seen in the right. frontal region and type 2 where in the right upper region was seen.
In type 1 the conduction pathway was seen to belong to the same type as the complete right bundle branch block and intype 2 the delayed conduction was seen in the right posterior basal region and included those of near normal heart. Very little enlargement of the QRS-T angle was seen with T loop concordant with QRS loop.
4) The changes in the QRS and T loop of i.r.b.b.b in ASD cases showed findings suggesting right hypertrophy together with the right bundle branch block type.
5) The characteristic changes of right heart hypertrophy was a large shift and protusion to the right anterior of the whole QRS loop and the discordant T loop resulting in an enlarged QRS-T angle. The horizontal clock-wise rotation postulated as the findings of right hypertrophy in the original method of Grishman was concluded as not being of absolute nature.
6) In W-P-W syndrome group showing right bundle block-like EKG findings the Δ vector faces the right anterior lower direction and with the elevation of the electrodes the spatial position of the Δ vector was seen to be enlarged further.
7) The changes in the vector loop due to the elevation of electrodes is the result of the reduction of vector forces toward the basal or apex region of the heart or the saggital direction.
The discordant QRS and T loop and enlargement of QRS-T angle seen in right hypertrophy which is different from that of normal and right bundle branch block holds much interest from the viewpoint of ventricular gradient.
