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		<h1 class="catchCopy">急増する高齢者循環器診療，その現場の悩みをエキスパートが解決！</h1>
		

		<h1 class="title">高齢者の循環器診療Q＆A<span class="version"></span></h1>
		<h2 class="subTitle">快適な人生を過ごしてもらう診療のツボ</h2>

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					編集：伊藤　浩（岡山大学大学院医歯薬学総合研究科循環器内科学教授）
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				<ul class="property"><li class="disc">B5判・200頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1966-3</li><li class="disc">2021年2月9日発行</li></ul>

				
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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">高齢社会を迎え循環器診療を必要とする高齢患者数が急増している．多くの合併症を有する高齢者の慢性心不全患者に対し，どのような治療を行えばよいのか．本書は，高齢者の心血管疾患の特徴や診断，病態の評価，治療目標など，現場が抱える悩みに，エキスパートが自らの意見を交えながらアドバイスを送る一冊．循環器専門医，プライマリケア医，老年医，および高齢者を介護するメディカルスタッフに向け，Q&Aスタイルで読みやすくまとめた．</section><section class="preface">序　文<br><br>　高齢社会を迎え循環器診療を必要とする高齢患者数が増加している．今でもわれわれが診療している患者の70～80％が高齢者，心不全に至っては入院患者の平均年齢が80歳以上である．そのような75歳以上の高齢者，さらに90歳以上の超高齢者は，心臓や血管の構造や生理的機能が若年者のそれとは異なるうえに，多くの合併症を抱えていることが多く，ガイドラインを遵守した治療が成立するか疑問な点も多い．また，薬剤代謝やポリファーマシーの問題も深刻である．さらに，身体機能や認知機能の低下に伴う介護などの社会的な問題も大きく，治療目標も生命予後の改善だけでよいのか，終末期医療をどうするのかなども問題である．<br>　それに対し，現在の循環器診療体制は急性心筋梗塞を念頭に置いた急性期診療に対応するものであり，高齢者で激増している多くの合併症を有する慢性心不全患者に必ずしも適しているとは言えない．われわれの診療根拠となるガイドラインもほとんどは75歳未満の患者を対象とした臨床試験の結果に基づくものであり，高齢者そして超高齢者にはその結果を演繹して用いているに過ぎない．ではこのような高齢循環器疾患患者にはどのような治療をするのがよいのであろうか．残念ながらまだエビデンスの極めて乏しい領域であり，そして治療目標も従来のそれとは異なるものにならざるを得ない．<br>　高齢者の心血管疾患の特徴はどのようなもので，どのように診断し，病態を評価し，どのような治療を行うのがよいのであろうか．さらに，その治療目標はどこに設定したらよいのであろうか．<br>　本書は，このような現場の悩みに対し，エキスパートが自らの意見を交えながら，循環器専門医，プライマリケア医，老年医，および高齢者を介護するメディカルスタッフにアドバイスを送っていただきたいという意味で企画した．エビデンスの乏しいところはエキスパートの経験・私見を強く打ち出してもらっている．目の前の患者の治療方針の決定や，診療に役に立ったと思っていただければ執筆者一同の大きな幸せである．<br><br>2021年2月<br>伊藤　浩</section><section class="indexes">序　文<br><br>Part 1　疫　学<br>　Q1｜高齢者で今後増加することが予想される循環器疾患は何でしょうか？<br><br>Part 2　機　序<br>　Q2｜加齢は生理的それとも病的変化，どう考えたらよいでしょうか？<br>　Q3｜心臓と動脈の加齢に伴う変化を教えてください<br><br>Part 3 診　察<br>　Q4｜高齢者の心血管疾患は意外と見逃されることが多いようです．臨床像に関して教えてください<br>　Q5｜高齢者の運動耐容能と運動時の心血管特性に関して教えてください<br>　Q6｜高齢者の身体所見の取り方にコツはあるのでしょうか？必ずすべきことはありますか？<br>　Q7｜合併症の多い高齢者において包括的に病態を評価するにはどうしたらよいですか？<br>　Q8｜フレイルの診断と心血管疾患との関係を教えてください<br>　Q9｜循環器診療をするうえで必要な認知機能評価と認知機能が低下している患者の対策に関して教えてください<br>　Q10｜高齢心血管疾患患者における栄養状態の評価にはどのような意義があるのでしょうか？具体的な方法も教えてください<br>　Q11｜サルコペニアや運動能力を評価するにはどうしたらよいでしょうか？外来でも行える簡単な方法があれば教えてください<br>　Q12｜高齢者でABIとPWV（CAVI）を測定することの意義に関して教えてください<br>　Q13｜高齢者における冠動脈石灰化スコアの意義に関して教えてください<br><br>Part 4　治　療<br>　Q14｜非心臓手術を予定した高齢者がいます．術前評価と周術期マネージメントについて教えてください<br>　Q15｜高齢者静脈血栓塞栓症（VTE）の疫学と診断・治療に関して教えてください．DOACはどこまでするのでしょうか？<br><br>Part 5　動脈硬化性疾患<br>　Q16｜高齢者のリスク因子は中高年のそれと同じと考えてよいのでしょうか？そして，リスク層別化はどうしたらよいのでしょうか？<br>　Q17｜高齢者の冠動脈疾患の診断はどのように行ったらよいでしょうか？<br>　Q18｜高齢者の冠血行再建の適応はどう考えればよいのでしょうか？薬物療法との選択で迷うことがあります<br>　Q19｜高齢者におけるPCIとCABGの選択はどうしたらよいでしょうか？<br>　Q20｜高齢者の急性心筋梗塞の特徴と治療について教えてください（合併症含む）<br>　Q21｜高齢者における抗血小板療法の選択と長期管理に関して教えてください<br>　Q22｜高齢者末梢動脈疾患（PAD）の治療適応と治療法に関して教えてください<br>　Q23｜高齢者の二次予防はどのようなことを優先して行いますか？それ以下の年齢層との相違はありますか？<br>　Q24｜高齢者大動脈解離の疫学と治療に関して教えてください<br>　Q25｜高齢者大動脈瘤の疫学と治療に関して教えてください<br>　Q26｜高齢者で原因がはっきりしない脳卒中いわゆるESUSの診断と治療に関して教えてください<br><br>Part 6　リスク因子の管理（一次予防）<br>　Q27｜高齢者の降圧療法の適応とその目標値はどうしますか？<br>　Q28｜高齢高血圧患者に対してはACE阻害薬それともARB？<br>　Q29｜高齢者のなかでβ遮断薬が適応となる症例と使い方を教えてください<br>　Q30｜高齢者におけるMRAの適応と注意点を教えてください<br>　Q31｜高齢者の脂質異常症の治療をどうしますか？目標値はどう設定しますか？<br>　Q32｜高齢者の心血管イベント予防としてアスピリンは入れたほうがよいのでしょうか？<br>　Q33｜高齢者の糖尿病の心血管イベント抑制を考えた治療方針はどうしたらよいでしょうか？<br>　Q34｜高齢者にメトホルミンやSGLT2 阻害薬を使用することのメリットとリスクを教えてください<br>　Q35｜高齢者に適した運動療法を含めた生活習慣の改善をどのように指導したらよいか教えてください<br><br>Part 7　心不全，弁膜症<br>　Q36｜高齢者心不全の現状と将来を教えてください<br>　Q37｜高齢者心不全の特徴と診断をどうしたらよいか教えてください<br>　Q38｜高齢者心不全の治療目標をどのように設定しますか？生命予後 vs QOL<br>　Q39｜高齢者HFrEFの治療を教えてください．治療上の注意点はありますか？<br>　Q40｜高齢者HFpEF患者の臨床的特徴とどのように診断するかに関して教えてください<br>　Q41｜HFpEF患者において心エコー図検査でどのような項目を評価したらよいのでしょうか？<br>　Q42｜高齢者HFpEFの心不全再入院を減らすためのポイントと薬物療法をどうすればよいか教えてください<br>　Q43｜老人性心アミロイドーシスの疫学・診断と治療方針を教えてください<br>　Q44｜高齢者大動脈弁狭窄症（AS）におけるTAVIの適応と治療にあたって注意すべき点を教えてください<br>　Q45｜高齢者に僧帽弁閉鎖不全は増加していると聞きます．その原因と治療方針に関して教えてください<br>　Q46｜高齢者三尖弁閉鎖不全症（TR）の病態と治療に関して教えてください<br>　Q47｜高齢者の感染性心内膜炎の特徴と治療に関して教えてください<br>　Q48｜慢性腎臓病（CKD）を合併する高齢者心不全の体液管理に関して教えてください<br>　Q49｜慢性閉塞性肺疾患（COPD）を合併する高齢者循環器疾患患者の治療に関して教えてください<br>　Q50｜高齢うっ血性心不全患者の急性期治療に関して教えてください<br>　Q51｜人生会議（ACP）をどの段階でどのように行ったらよいか，ノウハウを教えてください<br>　Q52｜緩和ケアをどのような体制でどう行ったらよいか教えてください <br><br>Part 8　不整脈<br>　Q53｜高齢者の心房細動の疫学とその合併症に関して教えてください<br>　Q54｜高齢者心房細動に対するアブレーションの適応はどのように考えたらよいでしょうか？<br>　Q55｜高齢心房細動患者のレートコントロールをどのように行いますか？その目標心拍数は？<br>　Q56｜高齢心房細動患者の抗凝固療法はどのようにしたらよいでしょうか？いつまで続けますか？薬剤の選択は？<br>　Q57｜心房細動患者の左心耳閉鎖デバイスの適応と治療後の管理に関して教えてください<br>　Q58｜高齢者のPVCとNSVTに対する治療方針を教えてください<br>　Q59｜徐脈性不整脈とペースメーカ治療の適応について教えてください<br>　Q60｜高齢者で増えている植込み型心臓電気デバイス感染症とリード抜去の適応に関して教えてください<br><br>Part 9　高齢者特有の問題<br>　Q61｜循環器疾患急性期から運動リハビリテーションをどのように行ったらよいか教えてください<br>　Q62｜高齢心不全患者の退院を促すために多職種連携チーム医療をどうするか教えてください<br>　Q63｜高齢心不全患者の社会復帰，家庭への復帰を促すためにどのような工夫があるか教えてください<br>　Q64｜高齢心不全患者の退院後の運動はどのようにしたらよいか教えてください<br>　Q65｜ポリファーマシーの問題点が指摘されていますが，減薬のポイントを教えてください<br>　Q66｜高齢者で注意すべき循環器系薬剤に関して教えてください<br>　Q67｜高齢心不全患者を在宅で診ていくにはどうしたらよいか教えてください<br><br>索　引</section></article>
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