medicina51巻9号

2014年09月発行

特集 ここが知りたい循環器診療―パールとピットフォール 救急でよくみる循環器疾患

急性心筋梗塞の初期診療

著者： 柳澤智義¹ 阿古潤哉¹

所属機関： ¹北里大学医学部循環器内科学

ページ範囲：P.1649 - P.1657

パールとピットフォール

◎急性心筋梗塞の予後改善のためには，できるかぎり早期にprimary PCIを成功させる必要がある．

◎primary PCIの成功への鍵は，患者さんが来院してからの最初の10分以内に判断し，初期診断と初期治療を並行して行うことである．

◎急性心筋梗塞の診断アルゴリズムに従った診断法を身につける必要がある．

◎連続心電図モニターの装着が致死性不整脈の発見に重要である．

◎標準12誘導心電図は過去との比較が必要である．

◎標準12誘導心電図は背側部誘導（V₇～V₉）まで記録することが望ましい．

◎診断確定のための臨床検査結果，画像診断を待つことでprimary PCIが遅れてはいけない．

◎急性大動脈解離と肺血栓塞栓症との鑑別診断は慎重に行うべきである．

参考文献

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