循環器ジャーナル69巻2号

2021年04月発行

特集 エキスパートに学ぶ 知っておきたい心電図診断のコツと落とし穴 急性冠症候群と鑑別を要する疾患

急性肺塞栓症

著者： 猿渡力¹

所属機関： ¹済生会横浜市南部病院循環器内科

ページ範囲：P.220 - P.227

Point
・急性肺塞栓症では，初期診断の成否が予後を大きく左右するため，心電図などのスクリーニング検査が重要である．
・中等症以上の急性肺塞栓症では，特異性はないが何らかの心電図変化を認めることが多い．
・急性肺塞栓症の心電図では陰性T波の出現と分布に注意を向けることが重要である．

参考文献

1) 日本循環器学会，他編：肺血栓塞栓症および深部静脈血栓症の診断，治療，予防に関するガイドライン（2017年改訂版），2018

2) Carson JL, Kellev MA, Duff A, et al:The clinical course of pulmonary embolism. N Engl J Med 326:1240-1245, 1992

3) Gibson NS, Sohne M, Kruip MJ, et al:Further validation and simplification of the Wells clinical decision rule in pulmonary embolism. Thromb Haemost 99:229-234, 2008

4) Klok FA, Mos IC, Nijkeuter M, et al:Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med 168:2131-2136, 2008

5) Hendriksen JM, Geersing GJ, Lucassen WA, et al:Diagnostic prediction models for suspected pulmonary embolism:systematic review and independent external validation in primary care. BMJ 351:h4438, 2015

6) 岡田　修，佐久間聖仁，中村真潮，他．肺血栓塞栓症急性型と慢性肺高血圧型の診断手技と臨床病態　肺塞栓症研究会共同作業部会報告．Ther Res 22:1481-1486, 2001

7) Kumasaka N, Sakuma M, Shirato K:Clinical features and predictors of in-hospital mortality in patients with acute and chronic pulmonary thromboembolism. Intern Med 39:1038-1043, 2000

8) 小菅雅美：心電図で見方が変わる急性冠症候群（木村一雄監）．文光堂，pp66-81, 2015

9) Shopp JD, Stewart LK, Emmett TW, et al:Findings From 12-lead Electrocardiography That Predict Circulatory Shock From Pulmonary Embolism:Systematic Review and Meta-analysis. Acad Emerge Med 22:1127-1137, 2015

10) Stein PD, Dalen JE, McIntyre KM, et al:The electrocardiogram in acute pulmonary embolism. Prog Cardiovasc Dis 17:247-257, 1975

11) Jaff MR, McMurtry MS, Archer SL, et al:Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension:a scientific statement from American Heart Association. Circulation 123:1788-1830, 2011

12) Kosuge M, Kimura K, Ishikawa T, et al:Electrocardiographic differentiation between acute pulmonary embolism and acute coronary syndromes on the basis of negative T waves. Am J Cardiol 99:817-821, 2007

13) Kosuge M, Ebina T, Hibi K, et al:Differences in negative T waves between acute pulmonary embolism and acute coronary syndrome. Circ J 78:483-489, 2014

14) Kosuge M, Kimura K, Ishikawa T, et al:Prognostic significance of inverted T waves in patients with acute pulmonary embolism. Circ J 70, 750-755, 2006

15) Marriott HJL:Practical electrocardiography. 6th ed, Baltimore:William and Wilkins Co, 292-294, 1997

16) Kosuge M, Ebina T, Hibi K, et al:Differences in negative T waves among acute coronary syndrome, acute pulmonary embolism, and Takotsubo cardiomyopathy. Eur Heart J Acute Cardiovasc Care 1:349-357, 2012