そのPVCはどこから?

出版社: 中外医学社
著者:
発行日: 2022-09-20
分野: 臨床医学:内科  >  循環器一般
ISBN: 9784498137127
電子書籍版: 2022-09-20 (1版1刷)
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1枚の心電図に心室性期外収縮(PVC)が記録された時,あなたはそのPVCの起源をどこまで推定できますか? 本書では,日常的な不整脈診療やカテーテルアブレーションの術前評価に大いに役立つ12誘導心電図診断アルゴリズムについて,エビデンスに基づきながら起源推定のメソッドを詳細かつ平易に解説しました.

目次

  • 総論 12誘導心電図とPVC起源推定の基本ルール
      1.12誘導心電図の基本ルールを覚えましょう
      2.PVCの起源を推定しましょう
      3.PVC起源推定の練習

    I.流出路起源
     1.右室流出路起源の心室性不整脈
      1)解剖
      2)解剖に関する専門用語
      3)右室流出路起源を疑う心電図の特徴
      4)右室流出路の詳細な部位診断
       鑑別1 右室流出路か左室流出路か
       鑑別2 右室流出路弁上(肺動脈)か弁下か
       鑑別3 中隔か自由壁か
       鑑別4 前壁寄りか後壁寄りか

     2.左室流出路起源の心室性不整脈
      1)解剖
      2)解剖に関する専門用語
      3)左室流出路起源を疑う心電図の特徴
       鑑別1 右室流出路か左室流出路か
       鑑別2 大動脈弁上(冠尖)か弁下(上部中隔基部)か
       鑑別3 右冠尖か左冠尖かその間(左右冠尖交連部)か

    II.流入路起源
     1.右室流入路(三尖弁輪)
      1)解剖
      2)解剖に関する専門用語
      3)右室流入路(三尖弁輪)起源を疑う心電図の特徴
      4)右室流入路の詳細な部位診断
       鑑別1 中隔側か自由壁側か
       鑑別2 後壁起源か前壁起源か
      5)右室流入路起源不整脈の12誘導心電図診断アルゴリズムのまとめ

     2.左室流入路
      1)解剖
      2)解剖に関する専門用語
      3)僧帽弁輪,AMC起源PVCの12誘導波形の特徴
      4)僧帽弁輪中隔起源 vs 側壁起源の鑑別
      5)僧帽弁輪前壁 vs AMC vs 左冠尖起源の鑑別

    III.その他の起源
     1.その他の右室起源(His束近傍,moderator band)
      1)解剖に関する専門用語
      2)12誘導心電図から起源を推定する

     2.乳頭筋起源,ベラパミル感受性心室頻拍(VT)
      1)解剖
      2)解剖に関する専門用語
      3)乳頭筋起源を疑う心電図の特徴
      4)右脚ブロックを呈するPVC:他の起源との鑑別
       鑑別1 僧帽弁輪起源PVCとの鑑別
       鑑別2 脚枝起源PVCとの鑑別
      5)ベラパミル感受性心室頻拍(VT)

    IV.心外膜起源
     1.LV summit起源の心室性不整脈
      1)解剖
      2)解剖に関する専門用語
      3)LV summit起源を疑う心電図の特徴
      4)LV summitの詳細な部位診断
       鑑別1 LV summit起源か,他の流出路起源か
      5)LV summit起源不整脈の12誘導心電図診断アルゴリズムのまとめ

     2.crux領域の心室性不整脈
      1)解剖
      2)解剖に関する専門用語
      3)crux領域起源を疑う心電図の特徴
      4)crux areaの詳細な部位診断
       鑑別1 apical cruxか,basal cruxか
       鑑別2 crux領域と近接する部位との鑑別
      5)crux起源不整脈の12誘導心電図診断アルゴリズムのまとめ

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. 流出路起源

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II. 流入路起源

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III. その他の起源

P.64 掲載の参考文献
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6) Yamauchi Y, Aonuma K, Takahashi A, et al. Electrocardiographic characteristics of repetitive monomorphic right ventricular tachycardia originating near the His-bundle. J Cardiovasc Electrophysiol. 2005 ; 16 : 1041-8.
7) Yue-Chun L, Yuan-Nan L, Jing X, et al. R/S ratio in lead III predicts successful ablation of ventricular arrhythmias originating in para-hisian region. JACC Clin Electrophysiol. 2021 ; 7 : 719-30.
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IV. 心外膜起源

P.95 掲載の参考文献
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P.104 掲載の参考文献
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2) Kawamura M, Hsu JC, Vedantham V, et al. Clinical and electrocardiographic characteristics of idiopathic ventricular arrhythmias with right bundle branch block and superior axis : Comparison of apical crux area and posterior septal left ventricle. Heart Rhythm. 2015 ; 12 : 1137-44.
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