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		<h1 class="catchCopy">たかが心電図，されど心電図，臨床心電図学の奥は深い！</h1>
		

		<h1 class="title titleWidth">心電図で見方が変わる急性冠症候群<span class="version"></span></h1>
		

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					著：小菅雅美（横浜市立大学客員准教授）
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					監修：木村一雄（横浜市立大学教授）
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				<ul class="property"><li class="disc">B5判・100頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1925-0</li><li class="disc">2015年4月1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">実際に患者さんを目の前にしていざ心電図を読もうとしても教科書に書いてあるような典型例ばかりではなく診断が容易ではないことは多い．本書は，灌流域や閉塞部位の違いから心電図の波形が異なることを理解し，心筋梗塞を診断することに主眼を置いている．著者が自らの臨床経験で学んだ臨床心電図学を提示しているため，“心電図を臨床に活かす”という観点から，必ず役立つ内容となっている．<br>☆図版28点，モノクロ写真268点</section><section class="preface">たかが心電図，されど心電図，臨床心電図学の奥は深い<br><br>　各種画像診断が飛躍的に進歩した現在においても， 心電図は“いつでも，どこでも，その場ですぐに行うことができる”簡便な検査であり循環器診断の基本であることに変わりはありません．しかし医師になり，実際に患者さんを目の前にしていざ心電図を読もうとしても教科書に書いてあるような典型例ばかりではなく診断が容易ではないことを痛感しました． 学生時代の心電図の講義は， まず活動電位， イオン電流，Einthovenの三角形……と基礎的解説から始まりますが，自分には難しくて理解できず，試験のためにただ暗記するだけの心電図学でした．そんな心電図の知識では臨床現場で歯が立つわけがありません．しかも私は循環器内科に入局し， すぐに救命救急センターCCU勤務となりました．循環器救急疾患は急性期治療の成否が予後を規定するといっても過言ではなく，迅速かつ的確な診断が求められます．“心電図を読めなければ話にならない”そう思って心電図の書を探しましたが臨床現場で役立つような実践的な本は見つからず心電図を読めないままに日々過ごしていました．そんな時，急性下壁梗塞患者の緊急心臓カテーテル検査に立ち会っている時に“何例も急性下壁梗塞患者の心電図を見てきたけれど症例によって心電図が違う！”と思いました．そして，冠動脈造影所見を見て“下壁梗塞といっても， 右冠動脈の灌流域や閉塞部位は症例により異なるのだから心電図も同じにはならないのだ”と気がついたのです．考えてみれば当然のことですが，私にとっては驚きでした．昔と違い今は冠動脈造影検査が普及し心電図所見と冠動脈造影所見の対比が可能です．“自分で心電図を勉強してみよう”と思い，入院した急性心筋梗塞患者1例1例の冠動脈造影所見と心電図を手書きでスケッチし，両者を対比していきました．初めは何もわからず手探りの状態でしたが，症例を積み重ねるにつれ心電図と冠動脈造影所見との関係について自分なりに新しい発見があり，それを学会や論文で発表してきました．今回，それらを1冊の本としてまとめることになりました．本書で述べたのは私が臨床経験から学んだ臨床心電図学であり（内容をよく理解してもらえるよう図やイラストはデフォルメされている部分もあります）， 心電図の見方・考え方は推測の域を出ず，心電図の専門家からは批判を受けるかもしれません．けれども“心電図を臨床に活かす”という観点に立てば役立つものだと思います．<br>　心電図から得られる情報は限りなく測り知れません．心電図を生かすも殺すも読み手次第です．本書が読者の皆さんの心電図に対する意識を変え，今後の診療の援けになることを心より願っております．<br>　最後に本書に掲載されている心電図を中心とした資料はすべて横浜市立大学附属市民総合医療センター救命救急センターおよび心臓血管センターで記録されたものであり，昼夜を問わず診療に携わる両スタッフのご協力ならびに梅村敏教授， 木村一雄教授のご指導の上に執筆できたと思っており，この場を借りて厚く御礼申し上げます．<br><br>2015年4月<br>横浜市立大学附属市民総合医療センター<br>小菅雅美</section><section class="indexes">第I章　総論<br>　1．急性冠症候群の概念と意義<br>　2．心電図の意義<br>第II章　ST上昇型急性心筋梗塞<br>　1．ST上昇の診断<br>　2．冠動脈の閉塞部位診断─基礎知識─<br>　3．急性前壁梗塞<br>　4．急性前壁梗塞との鑑別疾患─たこつぼ型心筋症─<br>　5．左主幹部閉塞による急性心筋梗塞<br>　6．急性下壁梗塞<br>　7．急性後壁梗塞<br>　8．急性側壁梗塞<br>第III章　非ST上昇型急性冠症候群<br>　1．ST低下<br>　2．aV<sub>R</sub>誘導のST上昇<br>　3．陰性T波<br>　4．陰性U波<br>　5．急性冠症候群との鑑別疾患─急性大動脈解離─<br>MEMO<br>　非ST上昇型急性冠症候群のリスク評価<br>　心電図の性差<br>　心電図診断のコツとポイント<br>　ST低下には2つのパターンがある<br>　たこつぼ型心筋症の診断基準<br>　QRS幅の延長<br>　心電図診断のピットホール<br>　－aV<sub>R</sub>誘導の陰性T波<br>索引</section></article>
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