今日の治療 不整脈の診断と治療

出版社： 永井書店
著者：
発行日： 1988-06-10
分野： 臨床医学：内科  >  心臓
ISBN： 9784815914349
電子書籍版： 1988-06-10
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本書では不整脈学習の効率を高めるため、個々の不整脈の基本的パタンの説明に加え、基本的パタンからの variationを基礎的な電気生理学的背景とともに記した。治療面からはその不整脈が今治療すべきかどうか、治療すべきであれば、その緊急度はどうかに重点を置いて解説し、次に実際の治療法を具体的に記した。(「序」より)

目次

  • 表紙
  • 共同執筆者および執筆協力者
  • 監修のことば
  • 序
  • 目次
  • I. 不整脈総論
  • 1. 特殊刺激伝導系と心臓の調律
  • A. 特殊刺激伝導系の構造
  • 1) 洞結節
  • 2) 結節間伝導路
  • 3) 房室結節
  • 4) ヒス束および心室内刺激伝導路
  • B. 特殊刺激伝導系の電気生理と心臓の調律
  • 1) 心筋細胞の活動電位と自動能
  • MEMO : fast responseとslow response
  • 2) 再分極と不応期
  • 3) 活動電位第0相の立ち上がり速度と伝導速度
  • C. 異所性刺激生成異常と不整脈
  • 1) 自動能亢進による異所性刺激生成
  • 2) 再入現象 ( リエントリー )
  • MEMO : 回帰収縮
  • D. 刺激伝導異常と不整脈
  • 文献
  • 2. 不整脈心電図の見方
  • A. 心電図波形からその心拍の刺激生成部位を考える
  • B. P波とQRS波の関係を調べる
  • C. 複雑な不整脈へのアプローチ - 解析図の利用
  • D. 頻脈とその鑑別のポイント
  • 1) 頻脈とその鑑別のポイント
  • 2) 互いに鑑別が難しい頻脈
  • E. 徐脈とその鑑別のポイント
  • F. 1カ所だけRR間隔が短くみえる場合 ( 期外収縮 ) の鑑別のポイント
  • G. 1カ所だけRR間隔が延びたようにみえる場合の鑑別のポイント
  • 1) 1拍分とんだようにみえる場合
  • 2) 1拍分ほどではないが, そこだけRR間隔が延びたようにみえる場合
  • H. 他と異なった波形をもつQRS波が混じっている場合の鑑別のポイント
  • I. 2拍ずつ, ひとかたまりででている場合 ( 2段脈 ) の鑑別のポイント
  • J. 不整脈の診断と長時間連続記録心電図 ( ホルター心電図 )
  • K. ヒス束心電図
  • 1) 方法
  • 2) 記録
  • 3) 臨床応用
  • L. 不整脈の診断と運動負荷試験
  • 文献
  • 3. 不整脈治療総論
  • A. 不整脈治療の原則
  • 1) 緊急に治療しなければならないもの
  • 2) 準緊急に治療しなければならないもの
  • 3) 急ぐ必要はないが, 治療した方がよいもの
  • B. 不整脈と血行動態
  • 1) 心拍数と血行動態
  • 2) 心収縮様式と血行動態
  • 3) 不整脈と心筋酸素需給バランス
  • C. 基礎疾患と不整脈治療
  • D. 抗不整脈剤の種類と使いかた
  • 1) 種類
  • 2) 徐脈性不整脈に対する薬剤
  • 3) 頻脈性不整脈に対する薬剤
  • MEMO : I群抗不整脈剤の分類 ( fast drugとslow drug )
  • 4) ジギタリス剤
  • E. 人工ペースメーカ
  • 1) 恒久的ペースメーカの適応
  • 2) ペースメーカジェネレータの開発と治療の進歩
  • MEMO : カテーテル電極と心筋電極
  • 3) ペースメーカ機種の選定
  • MEMO : ペースメーカ症候群
  • MEMO : 頻拍停止のためのペースメーカ
  • 4) 一時的ペーシング ( 体外式ペーシング )
  • 5) ペースメーカ植込み患者の管理とペーシング心電図の見方
  • F. 電気的除細動
  • 1) DC shockの歴史
  • 2) 除細動器の原理
  • 3) 適応と禁忌
  • 4) 手技
  • 5) 除細動および除細動器に関する問題点
  • G. 不整脈の外科治療
  • 1) WPW症候群
  • 2) 心室頻拍
  • 文献
  • II. 不整脈各論
  • 1. 洞調律とその異常
  • A. 診断
  • MEMO : ペースメーカ移動
  • B. 臨床的意味と治療の選択
  • C. 治療
  • 2. 上室性期外収縮
  • A. 診断
  • 1) 上室性期外収縮のはいり方
  • 2) 上室性期外収縮の特殊な形
  • B. 臨床的意義と治療の選択
  • 1) 基礎心疾患
  • 2) 血行動態
  • 3) 治療の必要性
  • C. 治療
  • 文献
  • 3. 発作性上室性頻拍
  • A. 診断
  • 特殊な形の上室性頻拍症
  • B. 臨床的意義と治療の選択
  • 1) 基礎疾患
  • 2) 血行動態
  • 3) 虚血性心疾患を有する場合
  • 4) 早期興奮症候群と発作性上室性頻拍
  • C. 治療
  • 1) 発作性上室性頻拍時の処置
  • 2) 上室性頻拍発作の予防
  • MEMO : 上室性頻拍の発生メカニズム
  • 文献
  • 4. 心房細動
  • A. 診断
  • 1) 特殊な形の心房細動
  • 2) 心房細動例でみられる幅広い異常QRS波の鑑別
  • MEMO : lone atrial fibrillation
  • MEMO : WPW症候群に伴う心房細動
  • B. 臨床的意味と治療の選択
  • 1) 心房細動と血行動態
  • 2) 心房細動と脳塞栓
  • C. 治療
  • 1) 心不全, 頻脈を伴う心房細動
  • 2) 心不全徴候はないが頻脈を示す心房細動
  • 3) 除細動
  • 文献
  • 5. 心房粗動
  • A. 診断
  • 発作性上室性頻拍か心房粗動か
  • B. 臨床的意義と治療の選択
  • 1) 基礎心疾患
  • 2) 心房粗動の不安定性
  • 3) 血行動態
  • C. 治療
  • 文献
  • 6. 心室性期外収縮
  • A. 診断
  • 1) 心室性期外収縮のはいり方
  • 2) 心室性期外収縮とP波
  • MEMO : 二段脈の法則
  • MEMO : 副調律
  • B. 臨床的意義と治療の選択
  • 1) 基礎心疾患
  • 2) 治療の必要性
  • 3) 危険な形の心室性期外収縮
  • MEMO : 運動と心室性期外収縮
  • MEMO : 心室性期外収縮重症度に関するLownの分類
  • MEMO : 心不全と心室性期外収縮
  • C. 治療
  • 文献
  • 7. 心室頻拍
  • A. 診断
  • 心室頻拍の鑑別診断
  • B. 臨床的意義と治療の選択
  • C. 治療
  • 1) 心室頻拍の停止
  • 2) 心室頻拍停止後の処置
  • MEMO : accelerated idioventricular rhythm ( slow ventricular tachycardia )
  • MEMO : 二方向性心室頻拍
  • MEMO : atypical ventricular tachycardia
  • 参考 : 不整脈源性右室異形成
  • 文献
  • 8. 心室細動
  • A. 診断
  • B. 治療
  • 1) 心室細動時の処置
  • 2) 除細動成功後の処置
  • 9. 洞房ブロック
  • A. 診断
  • B. 臨床的意義と治療の選択
  • C. 治療
  • MEMO : ウェンケバッハ現象を示す洞房ブロック
  • 10. 房室ブロック
  • A. 診断
  • 1) 第1度房室ブロック
  • 2) 第2度房室ブロック
  • 3) 第3度房室ブロック
  • B. 臨床的意義と治療の選択
  • 1) 第1度房室ブロック
  • 2) 第2度I型の房室ブロック ( ウェンケバッハ周期 )
  • 3) 第2度II型 ( モービッツII型 ) の房室ブロック
  • 4) 第3度房室ブロック ( 完全房室ブロック )
  • 5) アグムス・ストークス発作を起こしたもの
  • C. 治療
  • 文献
  • 11. 房室解離と補充調律
  • A. 診断
  • B. 臨床的意義と治療の選択
  • 文献
  • 12. 心室内伝導障害
  • A. 心室内変行伝導
  • B. 脚ブロック
  • 1) 心拍数に依存した脚ブロック
  • 2) 左脚分枝ブロックと二束ブロック, 三束ブロック
  • 3) 交代性脚ブロック
  • 文献
  • III. 不整脈が問題となる症候群, 病態
  • 1. 洞不全症候群
  • A. 洞不全症候群の種類と心電図波形
  • B. 洞不全症候群の診断
  • 1) ホルター心電図記録
  • 2) 頸動脈洞マッサージおよび眼球圧迫試験
  • 3) 運動負荷試験およびアトロピン静注法
  • 4) 洞結節回復時間および自動能回復時間の測定
  • C. 洞不全症候群の病態と治療
  • 文献
  • 2. QT延長症候群と心室性不整脈
  • MEMO : QT時間と心拍数
  • MEMO : QT延長症候群とT波の変化
  • MEMO : 遺伝性QT延長症候群と星状神経節切除
  • 文献
  • 3. 早期興奮症候群 ( WPW症候群, LGL症候群 ) と頻脈性不整脈
  • A. WPW症候群と心電図波形
  • B. WPW症候群と頻拍発作
  • C. WPW症候群の治療
  • MEMO : WPW症候群とその類縁の疾患
  • MEMO : WPW症候群の頻拍発作の誘発
  • 文献
  • 4. ジギタリス中毒と不整脈
  • A. ジギタリスの電気生理学的作用
  • B. ジギタリス中毒と調律異常
  • 1) 徐脈性不整脈と頻脈性不整脈の合併
  • 2) 特別な原因がない房室伝導障害
  • 3) 多源性・多発性心室性期外収縮, 二方向性心室頻拍
  • C. ジギタリス中毒に関する臨床的事項
  • MEMO : ジギタリス血中濃度と心室性期外収縮
  • MEMO : 腎機能とジゴキシン投与量
  • D. ジギタリス中毒の治療
  • 1) カリウム剤の補給
  • 2) 異所性刺激生成亢進に対する処置
  • 3) 伝導障害に対する処置
  • 文献
  • 5. 急性心筋梗塞と不整脈
  • A. 心室性不整脈
  • 1) 心室性期外収縮
  • 2) 心室頻拍
  • 3) 心室細動
  • B. 徐脈性不整脈
  • 1) 洞性徐脈
  • 2) 洞房ブロック, 洞停止
  • 3) 房室ブロック
  • C. 上室性不整脈
  • 文献
  • 6. 電解質異常と不整脈
  • A. 血清カリウムと不整脈
  • B. その他の電解質異常と不整脈
  • 文献
  • 7. 一般外科手術と不整脈
  • A. 術前に何らかの不整脈が認められる場合
  • B. 術中にみられる不整脈
  • C. 術後にみられる不整脈
  • 文献
  • 索引
  • 和文索引
  • 欧文索引
  • 奥付

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

I. 不整脈総論

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II. 不整脈各論

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III. 不整脈が問題となる症候群, 病態

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