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<title>令和の心不全治療ガイド | 株式会社文光堂</title>


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<meta name="description" content="近年，心不全患者は増加の一途を辿り，同時に新規治療薬が続々と登場し，治療にも大きな変化が起こった．本書では，そんな変化の激しい心不全診療についていけないという声に応えて，最新の知識を効率よくアップデートできるよう要点を絞って解説した．現在の治療戦略の考え方から，在宅医療，心不全緩和ケアの話題まで，最新のガイドラインのさらに一歩先に行く内容も含めて記載した．心不全診療に携わる医師，メディカルスタッフ">

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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">近年，心不全患者は増加の一途を辿り，同時に新規治療薬が続々と登場し，治療にも大きな変化が起こった．本書では，そんな変化の激しい心不全診療についていけないという声に応えて，最新の知識を効率よくアップデートできるよう要点を絞って解説した．現在の治療戦略の考え方から，在宅医療，心不全緩和ケアの話題まで，最新のガイドラインのさらに一歩先に行く内容も含めて記載した．心不全診療に携わる医師，メディカルスタッフは必携の一冊．</section><section class="preface">序 文<br><br>　心不全患者は増加の一途をたどっており，今や誰でも発症しうる疾患，common diseaseとされている．今後，心不全診療には循環器医だけではなく，内科医やかかりつけ医も関わることが必要であるが，現状は心不全診療に対して抵抗感を感じている医師が多いのも現実である．その理由として，心不全患者は急変しやすい，病態が複雑でわかりにくい，再入院を繰り返しすっきり治らない，心不全治療に手詰まり感がある，などが挙げられている．令和になり，そのようなことを言っていられない事態が進行している．超高齢心不全患者数が増加し，救急診療を圧迫するとともに，かかりつけ医が診療している患者も次々と心不全を発症するという現実が突きつけられている．我々は，患者を救うために否応なく心不全に立ち向かわなければならなくなった．<br>　幸いなことに，心不全の診療にパラダイムシフトというべき大きな変化が起きている．ざっと挙げるだけでも，<br>　・治療目標の変更：生命予後の改善から QOL 維持や心不全再入院予防へ<br>　・収縮不全 heart failure with reduced ejection fraction（HFrEF）患者の治療戦略の確立<br>　・TAVI や MitraClip などの治療デバイスの開発<br>　・心不全の早期診断による発症予防の推進<br>　・心不全療養指導士の資格をもつメディカルスタッフが中心となったチーム医療の展開<br>　・生活習慣の改善を含む心臓リハビリテーションの重要性の認識<br>　・advance care planning と緩和ケアへの関心の高まり<br>などである．<br>　心不全の病態が解明されるにつれて，その予防の重要性が認識され，新規心不全治療薬を取り込んだ治療戦略が確立し，そしてメディカルスタッフとともにチームで心不全患者を診療するというコンセプトが確立してきた，「ハートチームで心不全診療を行う」これが令和の心不全診療であるが，大切なのはメディカルスタッフと心不全診療の最新情報を共有することである．<br>　本書は医師およびメディカルスタッフの「心不全の病態はわかりにくい」「最新の心不全治療についていけない」という声に応えるべく，最新の心不全診療に関してテーマを絞ってわかりやすく解説するものである．執筆するエキスパートからは最新のガイドラインさらに今後の方向性を見据えて一歩先に行く内容を，具体的かつわかりやすく述べていただいている．<br>　本書が診療の役に立ったと思っていただければ執筆者一同の喜びである．<br><br>令和4年2月吉日<br>伊藤　浩<br></section><section class="indexes">総説<br><br>Ⅰ　HFrEFの治療up to date<br>　A　HFrEFに対する最新の治療戦略<br>　B　HFrEFの治療効果の判定には何を用いる？<br>　C　HFrEFの心拍管理におけるイバブラジンの使い方<br>　D　sGC刺激薬（ベルイシグアト）の作用機序と臨床エビデンス　<br>　E　HFrEFの機能性MR―to clip or not to clip<br>　F　HFmrEFとは何者か？ 治療はどのようにすべきか？<br>　G　CRTの有効性を上げる工夫，そしてCRT-P or CRT-Dの選択<br>　H　重症HFrEFの抗血栓療法はどうすべきか？<br>　I　高カリウム血症は本当にリスクなのか？―正常値の考え方と対処法up to date<br>　J　心臓移植とdestination therapyの現在地<br><br>Ⅱ　HFpEFの治療up to date<br>　A　HFpEFとは何者か？ 機序とphenotypeを考える<br>　B　HFpEFに対する最新の治療戦略<br><br>Ⅲ　急性期の心不全治療<br>　A　クリニカルシナリオに基づく急性心不全治療のノウハウ<br>　B　急性期に体液貯留を解除する―ループ利尿薬だけではない賢い体液管理<br>　C　超重症心不全の補助循環―IABP，PCPS（ECMO），IMPELLA，体外設置型VAD<br>　D　心不全急性期からの栄養補給をどうすべきか？<br><br>Ⅳ　心不全と不整脈の密接な見解<br>　A　心臓突然死を予防する治療薬<br>　B　心房細動に対するアブレーション治療―合併症例の適応は拡大している<br>　C　心室期外収縮との因果関係と治療を探る<br>　D　心室頻拍に対する最新の治療コンセプト<br>　E　ICDの適応を考える―S-ICDはどのような患者が対象になるか？<br><br>Ⅴ　心筋疾患による心不全を見逃さない<br>　A　ATTR心アミロイドーシスを見つける，治療する<br>　B　Fabry病を見つける，治療する<br>　C　心臓サルコイドーシスを診断し，治療する<br>　D　ハイリスク肥大型心筋症を見つける，治療する<br>　E　稀だが覚えておくべき心筋疾患<br>　F　たこつぼ心筋症（たこつぼ症候群）up to date <br>　G　周産期心筋症とはどのようなものか？―診断と治療up to date<br>　H　がん治療に伴う心不全とはどのようなものか？―診断と治療up to date<br>　I　急性そして劇症型心筋炎を診断し，治療する<br><br>Ⅵ　合併症とその治療戦略<br>　A　糖尿病患者の心不全発症予防，糖尿病治療薬の選択は？ <br>　B　高血圧患者ステージA，Bの治療戦略<br>　C　貧血と鉄欠乏―鉄剤とHIF-PH阻害薬 <br>　D　慢性腎不全患者の心不全治療薬の選択は？<br>　E　大動脈弁狭窄症に対するTAVI―超高齢であればすべて適応か？<br>　F　心不全患者における漢方の役割<br>　G　睡眠呼吸障害へのアプローチup to date<br>　H　非心臓手術における心不全患者の適応をどうするか？<br><br>Ⅶ　心不全再入院を予防する治療戦略<br>　A　体液貯留を理解する―なぜ，心不全増悪と再入院の原因になるのか？<br>　B　急性・慢性心不全の体液貯留を治療し，予防する<br>　C　慢性期の心臓リハビリテーションをどのように継続して行うか？<br>　D　心不全患者をかかりつけ医がみるときに重要なポイントは？<br>　E　在宅患者の心不全治療は可能であるか？ <br>　F　心不全診療における心不全療養指導士の役割 <br>　G　advance care planning（ACP）と緩和ケアの実際 <br>　H　遠隔モニタリングと遠隔診療はどのようにすればよいのか？<br><br>Ⅷ　心不全診療で活かす検査<br>　A　MDCTを活用する<br>　B　MRIを活用する<br>　C　心筋シンチグラフィを活用する<br>　D　心エコー指標を慢性心不全の診療に活用する<br>　E　心不全診療に活かす心肺運動負荷試験，6分間歩行距離<br>　F　この血液検査は見逃すな<br>　G　確定診断に欠かせない心筋生検<br>　H　心不全でこそ活きる血行動態の理解<br><br>索引</section></article>
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