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

急性心膜炎

著者： 北方博規¹ 香坂俊¹

所属機関： ¹慶應義塾大学医学部循環器内科

ページ範囲：P.254 - P.260

Point
・急性心膜炎は，何らかの原因で心膜囊が炎症を起こしている状態を指す．
・心膜摩擦音や心囊液貯留といった身体所見，そして特徴的な心電図異常が診断に重要である．
・本稿では心電図所見を中心に急性心膜炎の特徴を振り返り，類似の症状を呈する虚血性心疾患やその他の胸部疾患との鑑別点を明確にしたい．

参考文献

1) Brucato A, Imazio M, Cremer PC, et al:Recurrent pericarditis:still idiopathic? The pros and cons of a well-honoured term. Intern Emerg Med 13:839-844, 2018

2) Imazio M, Gaita F. Acute and Recurrent Pericarditis. Cardiol Clin 35:505-513, 2017

3) Chiabrando JG, Bonaventura A, Vecchié A, et al:Management of Acute and Recurrent Pericarditis:JACC State-of-the-Art Review. J Am Coll Cardiol 75:76-92, 2020

4) Adler Y, Charron P, Imazio M, et al:2015 ESC Guidelines for the diagnosis and management of pericardial diseases:The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology（ESC）. Endorsed by:The European Association for Cardio-Thoracic Surgery（EACTS）. Eur Heart J 36:2921-2964, 2015

5) Spodick DH:Electrocardiogram in acute pericarditis. Distributions of morphologic and axial changes by stages. Am J Cardiol 33:470-474, 1974

6) Ariyarajah V, Spodick DH:Acute pericarditis:diagnostic cues and common electrocardiographic manifestations. Cardiol Rev 15:24-30, 2007

7) Imazio M:Acute pericarditis:Clinical presentation, diagnostic evaluation, and diagnosis. Up To Date, 2020

8) Ginzton LE, Laks MM:The differential diagnosis of acute pericarditis from the normal variant:new electrocardiographic criteria. Circulation 65:1004-1009, 1982

9) Spodick DH. Arrhythmias during acute pericarditis. A prospective study of 100 consecutive cases. JAMA 235:39-41, 1976

10) Imazio M, Cecchi E, Demichelis B, et al:Myopericarditis versus viral or idiopathic acute pericarditis. Heart 94:498-501, 2008

11) Rossello X, Wiegerinck RF, Alguersuari J, et al:New electrocardiographic criteria to differentiate acute pericarditis and myocardial infarction. Am J Med 127:233-239, 2014

12) LeWinter MM:Clinical practice. Acute pericarditis. N Engl J Med 371:2410-2416, 2014