medicina43巻9号

2006年09月発行

今月の主題 循環器薬の使い方 2006 循環器疾患に対する薬物治療の基本

急性心不全

著者： 藤井応理¹ 蔦本尚慶¹ 堀江稔¹

所属機関： ¹滋賀医科大学循環器内科

ページ範囲：P.1460 - P.1466

ポイント

急性心不全の予後はきわめて不良であり，迅速な診断のうえ，強心薬などの薬物療法や呼吸管理，機械的循環補助などあらゆる手段を講じて，呼吸循環動態の安定化に努めなくてはならない．

治療薬選択はSwan-Gantzカテーテルの有無にかかわらず，Forrester分類を念頭に行う．

治療の基本は利尿薬と血管拡張薬であり，強心薬の使用は必要最小限にとどめる．

参考文献

１) Forrester JS, Diamond GA, Swan HJ：Correlative classification of clinical and hemodynamic function after acute myocardial infarction. Am J Cardiol 39：137-145, 1977

２) Guidelines for the evaluation and management of heart failure；Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines(Committee on Evaluation and Management of Heart Failure). Circulation 92：2764-2784, 1995

３) Nieminen MS, et al：Executive summary of the guidelines on the diagnosis and treatment of acute heart failure；The Task Force on Acute Heart Failure of the European Society of Cardiology. Eur Heart J 26：384-416, 2005

４) 循環器病の診断と治療に関するガイドライン(1988-1999年度合同研究班報告)―急性重症心不全治療ガイドライン. J Circ J 64：1129-1165, 2000

５) Tsutamoto T, et al：Attenuation of compensation of endogenous cardiac natriuretic peptide system in chronic heart failure；Prognostic role of plasma brain natriuretic peptide concentration in patients with chronic symptomatic left ventricular dysfunction. Circulation 96：509-516, 1997

６) Killip T, 3rd, Kimball JT：Treatment of myocardial infarction in a coronary care unit；A two year experience with 250 patients. Am J Cardiol 20：457-464, 1967

７) Nohria A, Lewis E, Stevenson LW：Medical management of advanced heart failure. JAMA 287：628-640, 2002

８) Hayashi M, et al：Intravenous atrial natriuretic peptide prevents left ventricular remodeling in patients with first anterior acute myocardial infarction. J Am Coll Cardiol 37：1820-1826, 2001

９) Ishikawa C, et al：Inhibition of aldosterone and endothelin-1 by carperitide was attenuated with more than 1 week of infusion in patients with congestive heart failure. J Cardiovasc Pharmacol 46：513-518, 2005

10) Felker GM, et al：Heart failure etiology and response to milrinone in decompensated heart failure；Results from the OPTIME-CHF study. J Am Coll Cardiol 41：997-1003, 2003

11) Califf RM, et al：A randomized controlled trial of epoprostenol therapy for severe congestive heart failure：The Flolan International Randomized Survival Trial(FIRST). Am Heart J 134：44-54, 1997