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特集 血液透析―カレントトピックス
文献概要
要旨 心不全とは，心室の収縮能や拡張能の障害に由来する臨床徴候であり，その主症状は臓器のうっ血である。原因として，無症候性心筋虚血の頻度が高く，透析導入時より積極的な虚血性心疾患のスクリーニングをすべきである。心筋虚血が疑われる場合には，心臓超音波検査を施行し，心筋シンチグラフィなど非侵襲的検査による精査を進めるべきである。ドライウェイト（DW）の是正とともに，心血管系薬物療法に加え，高血圧，糖尿病，脂質異常症および喫煙など危険因子の改善が望ましい。また，無症候性の心雑音，うっ血性心不全や失神，狭心症および透析困難症を伴う心雑音を聴取する透析患者では，心臓弁膜症を鑑別することが重要である。急性弁膜症では，感染性心内膜炎を鑑別する。軽症および中等症の弁膜症では心エコー検査を定期的に行い，重症で手術適応のある患者では手術治療時期を逃さないことが大切である。
参考文献
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