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<title>この1冊で極める胸痛の診断学 | 株式会社文光堂</title>


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<meta name="description" content="胸痛という主訴には，心筋梗塞や大動脈解離など緊急性の高い疾患をイメージすることが多いと思われるが，実際には呼吸器疾患や消化管疾患，あるいは皮膚疾患や整形外科的な疾患など，さまざまな疾患が胸痛を引き起こし，その緊急度や頻度もさまざまである．本書では，胸痛診療の基本から，知っておくべきメジャー/マイナーな鑑別疾患，病歴からのアプローチ，身体所見からのアプローチ，検査の組み立てと評価，ケーススタディと，">

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		<h1 class="catchCopy">担当医の胸の苦しさがすこし楽になる?!</h1>
		

		<h1 class="title">この1冊で極める胸痛の診断学<span class="version"></span></h1>
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					著：横江正道（名古屋第二赤十字病院第二総合内科部長）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">胸痛という主訴には，心筋梗塞や大動脈解離など緊急性の高い疾患をイメージすることが多いと思われるが，実際には呼吸器疾患や消化管疾患，あるいは皮膚疾患や整形外科的な疾患など，さまざまな疾患が胸痛を引き起こし，その緊急度や頻度もさまざまである．本書では，胸痛診療の基本から，知っておくべきメジャー/マイナーな鑑別疾患，病歴からのアプローチ，身体所見からのアプローチ，検査の組み立てと評価，ケーススタディと，胸痛の診断に至る考え方や知識をすみずみまで解説した．胸痛が苦手な人でも，あわてずに正確な診断をつけられるようになるための一冊．</section><section class="preface">序　文<br><br>　「胸が痛いんです！」と訴えて，病院や診療所に来られる患者さんは，なにかしらすでに緊急性が高いと医師は感じます．それは，心筋梗塞や狭心症，大動脈解離，肺塞栓や気胸などの鑑別診断が頭をよぎるからでしょう．しかも，一歩，間違うと命に危機が及ぶ病気が多く，また，一分一秒を争うこともあるため，医師もまた，胸をドキドキさせながら対応することになります．<br>　そんなことが目白押しの胸痛ですから，「胸痛は怖い」，「胸痛は苦手」という方も多いのではないでしょうか？<br>　私も決して，「胸痛が大好き！」というわけではないのですが，過去の経験から，この本を手に取っていただいた方に，少しでも落ち着いて対処できるよう，胸痛の診療をすることに少し自信を持ってもらうことができればと思っています．つまり，「胸痛の恐怖感」を減らすのがこの本の狙いです．<br>　でも，みなさんがすでに経験されているように，胸痛は，いつもいつも怖いものばかりではありません．実は怖い胸痛じゃなかったときに，なんだか，「あれは何だったんだろうか？」というような診断がとても悩ましいものだったことがある方も多いのではないかと思います．そのような意味で，胸痛の診療に不確かさを感じたときの「裏の胸痛の恐怖感」もあるような気がしてなりません．そうした悩ましい胸痛の正体に近づけるよう，この本ではあまりよく知られていない胸痛を起こす病気にもフォーカスを当てていきます．とにかく，怖がらずに，嫌がらずに胸痛にアプローチできるようになることを願っています．<br><br>　2019年4月<br>　横江正道</section><section class="indexes">第 I 章　胸痛診療の5ヵ条（総論）<br>　　①年齢という前提条件／②「胸痛」はぱっと見重視！まず見る！聞く！感じる！／③ヤバいの次はバイタルサイン／④ヤバい時こそ，酸素を流そう！／⑤余裕があってもなくても鑑別診断<br>第 II 章　見逃すわけにはいかないメジャーな胸痛<br>　〜いわゆる5Killer Chest Pain〜<br>　Ａ 急性冠症候群<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　Ｂ 大動脈解離<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　Ｃ 肺血栓塞栓症<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　Ｄ 緊張性気胸<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　Ｅ 特発性食道破裂<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>第 III 章　知っておくと役に立つ胸痛の鑑別疾患<br>　A 消化器関連<br>　　①GERD・逆流性食道炎／②びまん性食道けいれん／③アカラシア／④Mallory-Weiss症候群／⑤胃潰瘍，十二指腸潰瘍／⑥胆石発作／⑦急性胆囊炎／⑧急性膵炎<br>　B 呼吸器関連<br>　　①胸膜炎／②肺炎（膿胸，肺炎随伴性胸水貯留）／③気管支炎／④肺がん／⑤縦隔炎・縦隔洞炎<br>　C 心臓<br>　　①心膜炎（心外膜炎）／②大動脈弁狭窄症／③たこつぼ型心筋症<br>　D 皮膚・乳房<br>　　①帯状疱疹／②乳腺炎／③Mondor病<br>　E 肋骨・肋間<br>　　①肋骨骨折／②肋軟骨炎／③ティーツェTietze症候群<br>　F 胸骨・鎖骨関連<br>　　①sternalis syndrome（胸骨筋症候群）／②剣状突起痛／③胸鎖関節亜脱臼／④SAPHO症候群<br>　G 脊椎・椎体・椎間板関連<br>　　①頸椎症／②脊椎腫瘍・脊髄腫瘍／③脊椎圧迫骨折／④頸椎ヘルニア／⑤脊椎炎<br>　H その他<br>　　①不安神経症（心臓神経症・過換気症候群）／②パニック症（パニック障害）／③身体表現性障害／④precordial catch syndrome<br>第 IV 章　病歴からのアプローチ<br>　　　　〜主訴「胸痛」からの病歴への展開〜<br>　A 発症時間・経過<br>　B 胸痛の部位・放散痛<br>　C 痛みの性状<br>　D 痛みの強さ<br>　E 随伴症状<br>　F 増悪因子<br>　G 寛解因子<br>　H 危険因子<br>　I 既往歴・治療歴<br>第 V 章　身体所見からのアプローチ<br>　A 胸痛の鑑別に有用な診察所見<br>　　①頸部の診察／②胸部・胸郭の視診・触診／③心音の聴取／④呼吸音の聴取／⑤腹部の診察／⑥四肢の診察／⑦その他の所見<br>第 VI 章　検査の組み立てとその評価<br>　A 検査の流れ<br>　B 各検査<br>　　①血液検査（血算・生化学）／②12誘導心電図／③胸部X線／④胸部CT（単純・造影）／⑤肋骨単純X線／⑥MRI／⑦骨シンチグラフィ，Gaシンチグラフィなど／⑧超音波／⑨上部消化管内視鏡<br>第 VII 章　ケーススタディで学ぼう<br>　　　　　〜胸痛・胸部不快感で来院した11症例のファイル〜<br>　症例1　不安定狭心症<br>　症例2　STEMI（ST上昇型心筋梗塞）<br>　症例3　大動脈解離<br>　症例4　緊張性気胸<br>　症例5　急性心膜炎<br>　症例6　肺塞栓症<br>　症例7　食道破裂<br>　症例8　肺炎（肺炎球菌性肺炎）<br>　症例9　心臓神経症<br>　症例10　胸鎖関節炎<br>　症例11　逆流性食道炎<br>索　引<br><br>MEMO<br>　こんな胸痛もある！「がんの胸骨転移」<br>TOPICS<br>　胸やけって結構，複雑で難しい！<br>　胸膜癒着術<br>　肺炎を疑っているときに胸部単純X線写真はいつ撮るとよいのか？<br>　肺炎の診断に関して<br>　Lemierre症候群（頸静脈化膿性血栓症）<br>　心膜摩擦音<br>　Tietze症候群と肋軟骨炎の微妙な違い<br>　救急外来で診る胸痛患者におけるパニック障害の割合<br>Small Tips<br>　鉛中毒<br>私たちの経験<br>　病名がつく胸痛？つかない胸痛？<br>　ブラジャーのワイヤーがあたるところが痛い</section></article>
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