循環器ジャーナル66巻3号

2018年07月発行

特集 肺高血圧症Cutting Edge Ⅲ．肺高血圧症診断：診断のきっかけ，どんなサインが重要か？

見逃さないための症状，身体所見，初診時検査—心電図，胸部X線，血液検査

著者： 小川愛子¹

所属機関： ¹独立行政法人国立病院機構岡山医療センター臨床研究部分子病態研究室

ページ範囲：P.361 - P.367

Point
・労作時息切れ，胸痛，失神を主訴とする症例では，肺高血圧症を必ず鑑別診断に挙げる．
・労作時息切れの程度と運動耐容能の見極めには，具体的な問診と理学所見が重要である．
・心電図ではP波の増高，右軸偏位や右側胸部誘導のR波の増高・陰性T波，胸部X線では左第2弓の突出に注目する．

参考文献

1) Frantz RP, McGoon MD:An integrated approach to the diagnosis of pulmonary hypertension. In:A.J. Peacock, R. Naeije and L.J. Rubin, eds. Pulmonary circulation. 3rd edition, Hodder ＆ Stoughton Ltd., UK, pp170-194, 2011

2) Peacock AJ, Church C:Clinical features. In:A.J. Peacock, R. Naeije and L.J. Rubin, eds. Pulmonary circulation. 3rd edition, Hodder ＆ Stoughton Ltd., UK, pp81-99, 2011

3) Rich S, Dantzker DR, Ayres SM, et al:Primary pulmonary hypertension. A national prospective study. Ann Intern Med 107:216-223, 1987

4) Galiè N, Humbert M, Vachiery JL, et al:2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology（ESC）and the European Respiratory Society（ERS）:Endorsed by:Association for European Paediatric and Congenital Cardiology（AEPC）, International Society for Heart and Lung Transplantation（ISHLT）. Eur Heart J 37:67-119, 2016

5) Bonderman D, Wexberg P, Martischnig AM, et al:A noninvasive algorithm to exclude pre-capillary pulmonary hypertension. Eur Respir J 37:1096-1103, 2011

6) Sun PY, Jiang X, Gomberg-Maitland M, et al:Prolonged QRS duration:a new predictor of adverse outcome in idiopathic pulmonary arterial hypertension. Chest 141:374-380, 2012

7) Bossone E, Paciocco G, Iarussi D, et al:The prognostic role of the ECG in primary pulmonary hypertension. Chest 121:513-518, 2002

8) 佐藤慎二，小川愛子，更科俊洋，他：肺高血圧症の心電図変化．Therapeutic Research 32:1250-1252, 2011

9) Resten A, Maitre S, Humbert M, et al:Pulmonary hypertension:CT of the chest in pulmonary venoocclusive disease. AJR Am J Roentgenol 183:65-70, 2004

10) Frazier AA, Franks TJ, Mohammed TL, et al:From the Archives of the AFIP:pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis. Radiographics:a review publication of the Radiological Society of North America, Inc. 27:867-882, 2007

11) Hoeper MM, Bogaard HJ, Condliffe R, et al:Definitions and diagnosis of pulmonary hypertension. J Am Coll Cardiol 62:D42-50, 2013

12) Wolf M, Boyer-Neumann C, Parent F, et al:Thrombotic risk factors in pulmonary hypertension. Eur Respir J 15:395-399, 2000

13) Nakamura M, Okada O, Sakuma M, et al:Incidence and clinical characteristics of chronic pulmonary thromboembolism in Japan compared with acute pulmonary thromboembolism:results of a multicenter registry of the Japanese Society of Pulmonary Embolism Research. Circ J 66:257-260, 2002

14) Ogawa A, Satoh T, Fukuda T, et al:Balloon Pulmonary Angioplasty is a Safe and Effective Treatment for chronic Thrombombolic Pulmonary Hypertension:Results of a Multicenter Registry. Circ Cardiovasc Qual Outcomes 10:e004029, 2017

15) Nagaya N, Nishikimi T, Uematsu M, et al:Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 102:865-870, 2000