Title: Medicine
Tags: Subject::Cardiology Year::4 Type::Comparison Type::Flow Subject::Cardiology::Cardiac_Surgery::B_06 Subject::Cardiology::Cardiac_Surgery::B_05 Subject::Cardiology::Vascular_Medicine_and_Surgery::B_09 Subject::Cardiology::Vascular_Medicine_and_Surgery::B_11 Subject::Cardiology::Vascular_Medicine_and_Surgery::B_12 Subject::Cardiology::Vascular_Medicine_and_Surgery::B_14 Subject::Cardiology::Cardiothoracic_Surgery::B_21 Subject::Cardiology::Vascular_Medicine_and_Surgery::B_10

EnglishQuestion: What do S3 and S4 usually indicate in adults?
JapaneseQuestion: 成人でS3とS4は通常何を示すか？
EnglishAnswer: S3 reflects ventricular volume overload; S4 reflects atrial contraction into a stiff, poorly compliant ventricle.
JapaneseAnswer: S3は心室容量負荷、S4は硬くコンプライアンスの低い心室への心房収縮を反映する。

EnglishQuestion: Which valve lesions produce diastolic murmurs?
JapaneseQuestion: 拡張期雑音を生じる弁病変は？
EnglishAnswer: Mitral or tricuspid stenosis and aortic or pulmonary regurgitation.
JapaneseAnswer: 僧帽弁・三尖弁狭窄と、大動脈弁・肺動脈弁逆流。

EnglishQuestion: What is the classic murmur of aortic regurgitation?
JapaneseQuestion: 大動脈弁逆流の典型的雑音は？
EnglishAnswer: A high-pitched early diastolic decrescendo murmur, best heard at the right second intercostal space or left sternal border while sitting forward in expiration.
JapaneseAnswer: 高調性の拡張早期漸減性雑音。座位前屈・呼気時に右第2肋間または左胸骨縁で最も聴取しやすい。

EnglishQuestion: Why is acute aortic regurgitation especially dangerous?
JapaneseQuestion: 急性大動脈弁逆流が特に危険なのはなぜか？
EnglishAnswer: The LV has no time to adapt, so acute pulmonary edema and hemodynamic collapse can develop.
JapaneseAnswer: 左室が適応する時間がなく、急性肺水腫と血行動態破綻を来し得るため。

EnglishQuestion: What are the major causes of acute aortic regurgitation?
JapaneseQuestion: 急性大動脈弁逆流の主な原因は？
EnglishAnswer: Infective endocarditis, aortic dissection, and chest trauma.
JapaneseAnswer: 感染性心内膜炎、大動脈解離、胸部外傷。

EnglishQuestion: Which peripheral pulse findings may occur in severe chronic aortic regurgitation?
JapaneseQuestion: 重症慢性大動脈弁逆流でみられる末梢拍動所見は？
EnglishAnswer: Wide pulse pressure and hyperdynamic signs such as Corrigan pulse, de Musset sign, Quincke sign, and Traube or Duroziez signs.
JapaneseAnswer: 脈圧開大と、Corrigan脈、de Musset徴候、Quincke徴候、Traube・Duroziez徴候などの過動性所見。

EnglishQuestion: When is intervention indicated for aortic regurgitation?
JapaneseQuestion: 大動脈弁逆流の介入適応は？
EnglishAnswer: Symptoms, LV dilation, or LV dysfunction indicate valve repair or replacement.
JapaneseAnswer: 症状、左室拡張、左室機能障害があれば弁形成または置換を行う。

EnglishQuestion: What is the classic murmur of pulmonary regurgitation?
JapaneseQuestion: 肺動脈弁逆流の典型的雑音は？
EnglishAnswer: An early diastolic blowing decrescendo murmur at the left upper sternal border that increases with inspiration.
JapaneseAnswer: 左上胸骨縁の拡張早期吹鳴性漸減雑音で、吸気により増強する。

EnglishQuestion: What is the classic murmur of mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄の典型的雑音は？
EnglishAnswer: An opening snap followed by a low-pitched mid-diastolic rumble at the apex, best heard in the left lateral position during expiration.
JapaneseAnswer: opening snapに続く低調な拡張中期ランブルで、左側臥位・呼気時に心尖部で最も聴取しやすい。

EnglishQuestion: How does mitral stenosis produce pulmonary hypertension and embolism?
JapaneseQuestion: 僧帽弁狭窄はどのように肺高血圧と塞栓を起こすか？
EnglishAnswer: Reduced valve area raises LA pressure and causes LA dilation, leading backward to pulmonary hypertension and promoting atrial fibrillation and LA thrombus formation.
JapaneseAnswer: 弁口面積低下が左房圧上昇・左房拡張を起こし、後方へ肺高血圧を生じ、心房細動と左房血栓形成を促す。

EnglishQuestion: What is the most typical cause of mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄の最も典型的な原因は？
EnglishAnswer: Rheumatic fever following Streptococcus pyogenes infection.
JapaneseAnswer: A群溶血性連鎖球菌感染後のリウマチ熱。

EnglishQuestion: When is percutaneous mitral commissurotomy considered in severe mitral stenosis?
JapaneseQuestion: 重症僧帽弁狭窄で経皮的僧帽弁交連切開術を検討するのはいつか？
EnglishAnswer: When valve morphology is suitable and mitral valve area is below 1.5 cm².
JapaneseAnswer: 弁形態が適し、僧帽弁口面積が1.5 cm²未満の場合。

EnglishQuestion: What associated valve lesion should always be sought when tricuspid stenosis is diagnosed?
JapaneseQuestion: 三尖弁狭窄を診断したら必ず検索すべき併存弁膜症は？
EnglishAnswer: Mitral stenosis.
JapaneseAnswer: 僧帽弁狭窄。

EnglishQuestion: How do systolic ejection and regurgitant murmurs differ in configuration?
JapaneseQuestion: 収縮期駆出性雑音と逆流性雑音は形状がどう異なるか？
EnglishAnswer: Ejection murmurs are crescendo-decrescendo; regurgitant murmurs are pansystolic plateaus.
JapaneseAnswer: 駆出性雑音は漸増漸減型、逆流性雑音は全収縮期plateau型。

EnglishQuestion: Which lesions produce systolic ejection versus pansystolic regurgitant murmurs?
JapaneseQuestion: 収縮期駆出性雑音と全収縮期逆流性雑音を生じる病変は？
EnglishAnswer: Aortic and pulmonary stenosis produce ejection murmurs; mitral and tricuspid regurgitation produce pansystolic murmurs.
JapaneseAnswer: 大動脈弁・肺動脈弁狭窄は駆出性雑音、僧帽弁・三尖弁逆流は全収縮期雑音を生じる。

EnglishQuestion: What is the severe aortic stenosis valve-area threshold?
JapaneseQuestion: 重症大動脈弁狭窄の弁口面積基準は？
EnglishAnswer: Less than 1.0 cm².
JapaneseAnswer: 1.0 cm²未満。

EnglishQuestion: How does aortic stenosis progress to heart failure?
JapaneseQuestion: 大動脈弁狭窄はどのように心不全へ進むか？
EnglishAnswer: LV pressure overload causes concentric hypertrophy, increased oxygen demand, reduced compliance and rising filling pressure, then reduced stroke volume and systolic dysfunction.
JapaneseAnswer: 左室圧負荷が求心性肥大、酸素需要増加、コンプライアンス低下・充満圧上昇を起こし、一回拍出量低下と収縮不全へ進む。

EnglishQuestion: What is the classic symptomatic triad of aortic stenosis?
JapaneseQuestion: 大動脈弁狭窄の典型的三主徴は？
EnglishAnswer: Dyspnea, angina, and syncope.
JapaneseAnswer: 呼吸困難、狭心症、失神。

EnglishQuestion: What are the classic pulse and murmur findings of aortic stenosis?
JapaneseQuestion: 大動脈弁狭窄の典型的脈拍・雑音所見は？
EnglishAnswer: Pulsus parvus et tardus with narrow pulse pressure and a midsystolic crescendo-decrescendo murmur radiating to the carotids.
JapaneseAnswer: 遅く弱い脈と脈圧狭小、頸動脈へ放散する収縮中期漸増漸減雑音。

EnglishQuestion: Which echocardiographic velocity supports severe aortic stenosis?
JapaneseQuestion: 重症大動脈弁狭窄を支持する心エコー流速は？
EnglishAnswer: A peak aortic velocity of about 4 m/s.
JapaneseAnswer: 大動脈弁通過最高流速約4 m/s。

EnglishQuestion: How are SAVR and TAVI selected for aortic stenosis?
JapaneseQuestion: SAVRとTAVIはどのように選択するか？
EnglishAnswer: A Heart Team integrates age, life expectancy, anatomy, need for concomitant surgery, access, frailty, surgical risk, and patient preference.
JapaneseAnswer: Heart Teamが年齢、予測余命、解剖、併施手術、アクセス、frailty、手術リスク、患者希望を統合する。

EnglishQuestion: What is the classic murmur of pulmonary stenosis?
JapaneseQuestion: 肺動脈弁狭窄の典型的雑音は？
EnglishAnswer: A midsystolic crescendo-decrescendo murmur at the left upper sternal border, louder with inspiration, often with wide S2 splitting.
JapaneseAnswer: 左上胸骨縁の収縮中期漸増漸減雑音で吸気により増強し、S2幅広固定性分裂を伴い得る。

EnglishQuestion: When is invasive treatment recommended for pulmonary stenosis?
JapaneseQuestion: 肺動脈弁狭窄で侵襲的治療を推奨するのはいつか？
EnglishAnswer: For symptoms or a resting pressure gradient above 50 mmHg; balloon valvuloplasty is first-line.
JapaneseAnswer: 症状または安静時圧較差50 mmHg超。第一選択はballoon valvuloplasty。

EnglishQuestion: How do acute and chronic mitral regurgitation differ hemodynamically?
JapaneseQuestion: 急性と慢性の僧帽弁逆流は血行動態がどう異なるか？
EnglishAnswer: Acute MR abruptly raises pressure in a noncompliant LA, causing pulmonary edema and shock; chronic MR is initially compensated by LA/LV dilation but later causes LV dysfunction and pulmonary hypertension.
JapaneseAnswer: 急性MRは拡張していない左房圧を急上昇させ肺水腫・shockを起こす。慢性MRは左房・左室拡張で一時代償するが、後に左室機能障害・肺高血圧へ進む。

EnglishQuestion: What is the classic murmur of mitral regurgitation?
JapaneseQuestion: 僧帽弁逆流の典型的雑音は？
EnglishAnswer: A pansystolic plateau murmur best heard at the apex in the left lateral position and radiating to the left axilla.
JapaneseAnswer: 左側臥位で心尖部に最強、左腋窩へ放散する全収縮期plateau型雑音。

EnglishQuestion: What are the classic findings of tricuspid regurgitation?
JapaneseQuestion: 三尖弁逆流の典型所見は？
EnglishAnswer: A left sternal pansystolic murmur that becomes more prominent with inspiration, with systemic venous congestion such as raised JVP, edema, ascites, and pulsatile hepatomegaly.
JapaneseAnswer: 吸気で増強する左胸骨縁の全収縮期雑音と、JVP上昇、浮腫、腹水、拍動性肝腫大などの体静脈うっ血。

EnglishQuestion: How do primary and secondary cardiovascular prevention differ?
JapaneseQuestion: 心血管疾患の一次予防と二次予防はどのように異なるか？
EnglishAnswer: Primary prevention prevents a first event in people without established cardiovascular disease, whereas secondary prevention prevents recurrence or progression in people with established vascular disease.
JapaneseAnswer: 一次予防は心血管疾患がまだない人の初発を防ぎ、二次予防はすでに血管疾患がある人の再発・進行を防ぐ。

EnglishQuestion: Which established diseases place a patient in secondary cardiovascular prevention?
JapaneseQuestion: どのような既存疾患がある患者は心血管疾患の二次予防の対象となるか？
EnglishAnswer: Peripheral arterial disease, coronary heart disease, stroke, or transient ischemic attack.
JapaneseAnswer: 末梢動脈疾患、冠動脈疾患、脳卒中、一過性脳虚血発作がある場合。

EnglishQuestion: What benefits are expected from secondary cardiovascular prevention?
JapaneseQuestion: 心血管疾患の二次予防にはどのような効果が期待されるか？
EnglishAnswer: Improved quality of life and survival, with fewer recurrent infarctions and additional interventions.
JapaneseAnswer: 生活の質と生存期間を改善し、再梗塞や追加インターベンションを減らす。

EnglishQuestion: Which major drug classes may be used in secondary cardiovascular prevention?
JapaneseQuestion: 心血管疾患の二次予防で用いられる主な薬剤群は何か？
EnglishAnswer: Statins, antiplatelet drugs, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and beta blockers.
JapaneseAnswer: スタチン、抗血小板薬、アンジオテンシン変換酵素阻害薬またはアンジオテンシン受容体拮抗薬、β遮断薬。

EnglishQuestion: Which major cardiovascular risk factors are modifiable?
JapaneseQuestion: 修正可能な主な心血管リスク因子は何か？
EnglishAnswer: Smoking, hypertension, dyslipidemia, type 2 diabetes mellitus, and obesity.
JapaneseAnswer: 喫煙、高血圧、脂質異常症、2型糖尿病、肥満。

EnglishQuestion: Which major cardiovascular risk factors are non-modifiable?
JapaneseQuestion: 修正不能な主な心血管リスク因子は何か？
EnglishAnswer: Age, sex, and family history.
JapaneseAnswer: 年齢、性別、家族歴。

EnglishQuestion: How does smoking promote cardiovascular disease?
JapaneseQuestion: 喫煙はどのように心血管疾患を促進するか？
EnglishAnswer: It increases heart rate, blood pressure, and low-density lipoprotein; lowers high-density lipoprotein; and promotes plaque growth, platelet activation, endothelial dysfunction, and coronary spasm.
JapaneseAnswer: 心拍数・血圧・低比重リポ蛋白を上げ、高比重リポ蛋白を下げ、プラーク増大、血小板活性化、内皮障害、冠攣縮を促進する。

EnglishQuestion: Why does diabetes mellitus promote thrombosis?
JapaneseQuestion: 糖尿病はなぜ血栓形成を促進するか？
EnglishAnswer: It increases plasma coagulation and platelet aggregation and adhesion while reducing fibrinolysis.
JapaneseAnswer: 血漿凝固と血小板凝集・粘着を亢進させ、線溶を低下させるため。

EnglishQuestion: Which four inputs were used to read the former SCORE chart?
JapaneseQuestion: 旧SCOREチャートを読むために用いた4つの入力項目は何か？
EnglishAnswer: Sex and smoking status, age, systolic blood pressure, and total cholesterol.
JapaneseAnswer: 性別と喫煙状況、年齢、収縮期血圧、総コレステロール。

EnglishQuestion: What defined very high cardiovascular risk in the former SCORE framework?
JapaneseQuestion: 旧SCOREの枠組みで超高リスクを定義した所見は何か？
EnglishAnswer: Established cardiovascular disease; diabetes with target-organ damage or a major risk factor; glomerular filtration rate below 30 mL/min; or SCORE above 10%.
JapaneseAnswer: 確立した心血管疾患、標的臓器障害または重大なリスク因子を伴う糖尿病、糸球体濾過量30 mL/min未満、またはSCORE 10%超。

EnglishQuestion: What defined high cardiovascular risk in the former SCORE framework?
JapaneseQuestion: 旧SCOREの枠組みで高リスクを定義した所見は何か？
EnglishAnswer: A markedly elevated single risk factor; diabetes without additional high-risk features; glomerular filtration rate 30-59 mL/min; or SCORE 5-10%.
JapaneseAnswer: 単一リスク因子の著明な上昇、追加の高リスク所見を伴わない糖尿病、糸球体濾過量30〜59 mL/min、またはSCORE 5〜10%。

EnglishQuestion: Why should the former SCORE percentages not be applied directly to current treatment decisions?
JapaneseQuestion: 旧SCOREの割合を現在の治療判断へ直接適用すべきでないのはなぜか？
EnglishAnswer: Current European prevention guidance uses age- and region-appropriate SCORE2 or SCORE2-OP to estimate fatal and nonfatal events.
JapaneseAnswer: 現在の欧州予防指針では、年齢と地域に応じたSCORE2またはSCORE2-OPにより致死性・非致死性イベントを推定するため。

EnglishQuestion: What low-density lipoprotein goals are generally used for very-high- and high-risk patients?
JapaneseQuestion: 超高リスク患者と高リスク患者で一般に用いられる低比重リポ蛋白の目標は何か？
EnglishAnswer: Very high risk: below 1.4 mmol/L with at least a 50% reduction from baseline; high risk: below 1.8 mmol/L with at least a 50% reduction, individualized to the patient and guideline.
JapaneseAnswer: 超高リスクでは1.4 mmol/L未満かつ基準値から50%以上低下、高リスクでは1.8 mmol/L未満かつ50%以上低下を基本とし、患者背景と指針に応じて個別化する。

EnglishQuestion: What exercise and body-size goals support cardiovascular prevention?
JapaneseQuestion: 心血管予防を支える運動量と体格の目標は何か？
EnglishAnswer: Exercise 2.5-5 hours per week, preferably daily; body mass index 20-25 kg/m2; waist circumference below 94 cm in men and 80 cm in women.
JapaneseAnswer: 週2.5〜5時間、可能なら毎日の運動、体格指数20〜25 kg/m2、腹囲は男性94 cm未満・女性80 cm未満。

EnglishQuestion: What blood pressure and glycated hemoglobin goals are listed for cardiovascular prevention?
JapaneseQuestion: 心血管予防で示されている血圧と糖化ヘモグロビンの目標は何か？
EnglishAnswer: Blood pressure below 140/90 mmHg and glycated hemoglobin below 7% in diabetes, with individualization in practice.
JapaneseAnswer: 血圧140/90 mmHg未満、糖尿病では糖化ヘモグロビン7%未満を基本とし、実臨床では個別化する。

EnglishQuestion: Which platelet targets are inhibited by aspirin, clopidogrel or ticagrelor, and abciximab?
JapaneseQuestion: アスピリン、クロピドグレルまたはチカグレロル、アブシキシマブはそれぞれ何を阻害するか？
EnglishAnswer: Aspirin inhibits cyclooxygenase; clopidogrel and ticagrelor inhibit the adenosine diphosphate P2Y12 receptor; abciximab inhibits glycoprotein IIb/IIIa.
JapaneseAnswer: アスピリンはシクロオキシゲナーゼ、クロピドグレルとチカグレロルはアデノシン二リン酸P2Y12受容体、アブシキシマブは糖蛋白IIb/IIIaを阻害する。

EnglishQuestion: What is the defining structural and functional pattern of dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症を定義する構造・機能パターンは何か？
EnglishAnswer: Dilated cardiac chambers with reduced systolic function.
JapaneseAnswer: 心腔拡大と収縮機能低下。

EnglishQuestion: Which common cardiac conditions should be excluded before diagnosing cardiomyopathy?
JapaneseQuestion: 心筋症を診断する前に除外すべき一般的な心疾患は何か？
EnglishAnswer: Coronary artery disease, valvular disease, hypertension, and congenital heart disease.
JapaneseAnswer: 冠動脈疾患、弁膜症、高血圧、先天性心疾患。

EnglishQuestion: How do hypertrophic, restrictive, and dilated cardiomyopathy differ morphologically?
JapaneseQuestion: 肥大型・拘束型・拡張型心筋症は形態的にどう異なるか？
EnglishAnswer: Hypertrophic cardiomyopathy has marked wall thickening and a small cavity; restrictive cardiomyopathy has a normal-to-thick wall, normal-to-small ventricles, and often biatrial enlargement; dilated cardiomyopathy has relatively thin walls and a markedly enlarged cavity.
JapaneseAnswer: 肥大型は著明な壁肥厚と小さな心腔、拘束型は正常〜肥厚した壁と正常〜小さな心室および両心房拡大、拡張型は相対的に薄い壁と著明な心腔拡大を示す。

EnglishQuestion: What is the principal functional abnormality in restrictive cardiomyopathy?
JapaneseQuestion: 拘束型心筋症の主な機能異常は何か？
EnglishAnswer: Impaired diastolic filling caused by a stiff, fibrotic ventricle.
JapaneseAnswer: 硬く線維化した心室による拡張期充満障害。

EnglishQuestion: What pathology characterizes arrhythmogenic right ventricular cardiomyopathy?
JapaneseQuestion: 不整脈原性右室心筋症を特徴づける病理所見は何か？
EnglishAnswer: Desmosomal protein mutations cause fatty and fibrous replacement of the right ventricle, with dilation and aneurysm formation.
JapaneseAnswer: デスモソーム蛋白変異により右室が脂肪・線維組織へ置換され、拡張や瘤形成を来す。

EnglishQuestion: What is the compensatory-to-decompensatory sequence in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症における代償から非代償への流れは何か？
EnglishAnswer: Reduced contractility triggers Frank-Starling compensation, increased end-diastolic volume and preload, serial sarcomere addition with eccentric hypertrophy and dilation, then further reduction in contractility and ejection fraction.
JapaneseAnswer: 収縮力低下からフランク・スターリング機序、拡張末期容量・前負荷増加、サルコメア直列追加による偏心性肥大と拡張を経て、収縮力と駆出率がさらに低下する。

EnglishQuestion: Approximately what proportion of dilated cardiomyopathy is familial, and what inheritance pattern is common?
JapaneseQuestion: 拡張型心筋症のうち家族性は約何割で、どの遺伝形式が多いか？
EnglishAnswer: About 25% is familial, commonly with autosomal dominant inheritance.
JapaneseAnswer: 約25%が家族性で、常染色体優性遺伝が多い。

EnglishQuestion: Which infectious agent is a classic cause of myocarditis leading to dilated cardiomyopathy?
JapaneseQuestion: 心筋炎から拡張型心筋症を来す古典的な感染因子は何か？
EnglishAnswer: Coxsackie B virus.
JapaneseAnswer: コクサッキーBウイルス。

EnglishQuestion: Which toxic, endocrine, and rhythm-related factors can cause dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症を起こし得る毒性・内分泌・リズム関連因子は何か？
EnglishAnswer: Chronic alcohol exposure, hyperthyroidism, and persistent tachycardia such as atrial fibrillation.
JapaneseAnswer: 慢性アルコール曝露、甲状腺機能亢進症、心房細動などの持続性頻脈。

EnglishQuestion: Which symptoms of dilated cardiomyopathy mainly reflect heart failure?
JapaneseQuestion: 拡張型心筋症で心不全を反映する主な症状は何か？
EnglishAnswer: Dyspnea, fatigue, ascites, angina, and pulmonary edema.
JapaneseAnswer: 呼吸困難、疲労、腹水、狭心痛、肺水腫。

EnglishQuestion: Which physical findings suggest advanced dilated cardiomyopathy?
JapaneseQuestion: 進行した拡張型心筋症を示唆する身体所見は何か？
EnglishAnswer: Hypotension, elevated jugular venous pressure, narrow pulse pressure, edema, ascites, hepatomegaly, displaced apex, and functional mitral or tricuspid regurgitation murmurs.
JapaneseAnswer: 低血圧、頸静脈圧上昇、狭い脈圧、浮腫、腹水、肝腫大、心尖拍動偏位、機能性僧帽弁・三尖弁逆流雑音。

EnglishQuestion: What electrocardiographic abnormalities are common in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症でよくみられる心電図異常は何か？
EnglishAnswer: Left bundle branch block, atrial fibrillation, and ventricular arrhythmias.
JapaneseAnswer: 左脚ブロック、心房細動、心室性不整脈。

EnglishQuestion: What is the key echocardiographic role in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症における心エコーの中心的役割は何か？
EnglishAnswer: It establishes left ventricular dysfunction and evaluates chamber dilation, systolic and diastolic function, and annular dilation causing functional atrioventricular valve regurgitation.
JapaneseAnswer: 左室機能障害を確認し、心腔拡大、収縮・拡張機能、機能性房室弁逆流を生じる弁輪拡張を評価する。

EnglishQuestion: Why is Holter monitoring used in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症でホルター心電図を行う目的は何か？
EnglishAnswer: To detect prognostically important ventricular arrhythmias during 24-48 hours of recording.
JapaneseAnswer: 24〜48時間の記録で予後上重要な心室性不整脈を検出するため。

EnglishQuestion: Which thrombotic and rhythm complications occur in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症ではどのような血栓性・不整脈性合併症が起こるか？
EnglishAnswer: Intracardiac thrombus in the left ventricle or left atrial appendage, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.
JapaneseAnswer: 左室または左心耳の心腔内血栓、心房細動、心室頻拍、心室細動。

EnglishQuestion: What are the three broad treatment stages for dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症治療の大きな3段階は何か？
EnglishAnswer: Remove or treat the cause; provide guideline-directed heart failure and indicated anticoagulant therapy; then consider devices or transplantation in advanced disease.
JapaneseAnswer: 原因の除去・治療、標準的心不全治療と適応に応じた抗凝固療法、進行例でのデバイスまたは心移植の検討。

EnglishQuestion: At what left ventricular ejection fraction should an implantable cardioverter-defibrillator be considered in dilated cardiomyopathy?
JapaneseQuestion: 拡張型心筋症では左室駆出率がどの程度なら植込み型除細動器を検討するか？
EnglishAnswer: Below 35%, when otherwise indicated, to reduce sudden death from ventricular fibrillation.
JapaneseAnswer: 適応条件を満たす左室駆出率35%未満で、心室細動による突然死予防のため検討する。

EnglishQuestion: What defines hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症はどのように定義されるか？
EnglishAnswer: Left ventricular hypertrophy unexplained by other loading conditions, with predominantly diastolic dysfunction.
JapaneseAnswer: 他の負荷条件では説明できない左室肥大を示し、主に拡張障害を来す心筋症。

EnglishQuestion: Which genetic abnormality classically underlies hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症の基盤となる古典的な遺伝子異常は何か？
EnglishAnswer: A sarcomeric protein gene mutation, classically involving beta-myosin heavy chain.
JapaneseAnswer: サルコメア蛋白遺伝子変異で、代表例はβミオシン重鎖変異。

EnglishQuestion: Does every patient with hypertrophic cardiomyopathy have left ventricular outflow tract obstruction?
JapaneseQuestion: 肥大型心筋症では全例に左室流出路閉塞があるか？
EnglishAnswer: No. Septal-predominant hypertrophy is common, but not all patients have left ventricular outflow tract obstruction.
JapaneseAnswer: いいえ。心室中隔優位の肥厚は多いが、全例に左室流出路閉塞があるわけではない。

EnglishQuestion: How does systolic anterior motion worsen obstructive hypertrophic cardiomyopathy?
JapaneseQuestion: 収縮期前方運動は閉塞性肥大型心筋症をどのように悪化させるか？
EnglishAnswer: The mitral leaflet moves toward the hypertrophied septum during systole, increasing left ventricular outflow tract obstruction and mitral regurgitation.
JapaneseAnswer: 収縮期に僧帽弁尖が肥厚した中隔へ近づき、左室流出路閉塞と僧帽弁逆流を増強する。

EnglishQuestion: What pathophysiologic sequence links hypertrophic cardiomyopathy to dyspnea, syncope, and sudden death?
JapaneseQuestion: 肥大型心筋症が呼吸困難・失神・突然死へ至る病態の流れは何か？
EnglishAnswer: Hypertrophy causes outflow obstruction and reduced compliance; these lower cardiac output and raise filling pressure, producing syncope and dyspnea and increasing the risk of malignant arrhythmias and sudden death.
JapaneseAnswer: 肥厚により流出路閉塞とコンプライアンス低下が起こり、心拍出量低下と充満圧上昇から失神・呼吸困難を来し、致死性不整脈と突然死の危険が増す。

EnglishQuestion: What are the major symptoms of hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症の主な症状は何か？
EnglishAnswer: Dyspnea, angina, syncope, and palpitations; atrial or ventricular arrhythmias and sudden cardiac death may occur.
JapaneseAnswer: 呼吸困難、狭心痛、失神、動悸で、心房性・心室性不整脈や突然心臓死を起こし得る。

EnglishQuestion: Which auscultatory and palpatory findings suggest hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症を示唆する聴診・触診所見は何か？
EnglishAnswer: A forceful apical impulse, a fourth heart sound, and a midsystolic ejection murmur, sometimes with a pansystolic regurgitation murmur.
JapaneseAnswer: 強い心尖拍動、第4心音、収縮中期駆出性雑音で、ときに全収縮期逆流性雑音を伴う。

EnglishQuestion: What electrocardiographic findings are common in hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症でよくみられる心電図所見は何か？
EnglishAnswer: Left ventricular hypertrophy, pathological Q waves, and ST-T abnormalities.
JapaneseAnswer: 左室肥大、異常Q波、ST-T異常。

EnglishQuestion: What echocardiographic wall-thickness threshold supports hypertrophic cardiomyopathy in an adult?
JapaneseQuestion: 成人の肥大型心筋症を支持する心エコー上の壁厚基準は何か？
EnglishAnswer: End-diastolic wall thickness of at least 15 mm when not explained by another loading condition.
JapaneseAnswer: 他の負荷条件で説明できない拡張末期壁厚15 mm以上。

EnglishQuestion: What does cardiac magnetic resonance add to the evaluation of hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症の評価で心臓MRIは何を追加できるか？
EnglishAnswer: It better depicts hypertrophy, apical hypertrophic cardiomyopathy, and myocardial fibrosis.
JapaneseAnswer: 肥厚、心尖部肥大型心筋症、心筋線維化をより明瞭に描出する。

EnglishQuestion: Which conditions increase dynamic left ventricular outflow tract obstruction in hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症の動的左室流出路閉塞を増強する条件は何か？
EnglishAnswer: Standing, Valsalva maneuver, dehydration, reduced afterload from vasodilation, and increased contractility.
JapaneseAnswer: 立位、バルサルバ手技、脱水、血管拡張による後負荷低下、収縮力増加。

EnglishQuestion: Why do reduced preload and reduced afterload intensify the murmur of obstructive hypertrophic cardiomyopathy?
JapaneseQuestion: 前負荷または後負荷の低下で閉塞性肥大型心筋症の雑音が増強するのはなぜか？
EnglishAnswer: They make the left ventricular cavity smaller, increasing systolic anterior motion and dynamic outflow obstruction.
JapaneseAnswer: 左室内腔が小さくなり、収縮期前方運動と動的流出路閉塞が増強するため。

EnglishQuestion: How does squatting affect the murmur of obstructive hypertrophic cardiomyopathy, and why?
JapaneseQuestion: しゃがみ込みは閉塞性肥大型心筋症の雑音にどう影響し、その理由は何か？
EnglishAnswer: It reduces the murmur by increasing preload and afterload, thereby enlarging the left ventricular cavity.
JapaneseAnswer: 前負荷と後負荷を増やして左室内腔を広げるため、雑音を減弱させる。

EnglishQuestion: Why are beta blockers used in symptomatic hypertrophic cardiomyopathy?
JapaneseQuestion: 症候性肥大型心筋症でβ遮断薬を用いる理由は何か？
EnglishAnswer: They reduce heart rate and contractility, prolong diastolic filling, and lessen outflow obstruction and symptoms.
JapaneseAnswer: 心拍数と収縮力を低下させ、拡張期充満時間を延長し、流出路閉塞と症状を軽減するため。

EnglishQuestion: What is the role of non-dihydropyridine calcium-channel blockers in hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症における非ジヒドロピリジン系カルシウム拮抗薬の役割は何か？
EnglishAnswer: They slow the heart rate and improve diastolic filling.
JapaneseAnswer: 心拍数を抑え、拡張期充満を改善する。

EnglishQuestion: What is the sequence of alcohol septal ablation for obstructive hypertrophic cardiomyopathy?
JapaneseQuestion: 閉塞性肥大型心筋症に対するアルコール中隔焼灼術の手順は何か？
EnglishAnswer: Temporarily occlude a target septal perforator with a balloon, confirm by echocardiographic contrast that it supplies only the hypertrophied septum, then inject a small amount of alcohol to create a localized infarction and later septal thinning.
JapaneseAnswer: 標的中隔枝をバルーンで一時閉塞し、造影心エコーで肥厚中隔だけを灌流することを確認してから、少量のアルコールで限局性梗塞を作り、その後の中隔菲薄化を得る。

EnglishQuestion: What important conduction complication can follow alcohol septal ablation?
JapaneseQuestion: アルコール中隔焼灼術後に起こり得る重要な伝導合併症は何か？
EnglishAnswer: Atrioventricular block, requiring temporary pacing and conduction monitoring.
JapaneseAnswer: 房室ブロックで、一時ペーシングと伝導評価が必要となる。

EnglishQuestion: What is the principal purpose of an implantable cardioverter-defibrillator in hypertrophic cardiomyopathy?
JapaneseQuestion: 肥大型心筋症で植込み型除細動器を用いる主目的は何か？
EnglishAnswer: Prevention of sudden cardiac death from lethal ventricular arrhythmias.
JapaneseAnswer: 致死性心室性不整脈による突然心臓死の予防。

EnglishQuestion: How can hypertrophic cardiomyopathy cause heart failure despite a preserved ejection fraction?
JapaneseQuestion: 肥大型心筋症は駆出率が保たれていても、なぜ心不全を起こし得るか？
EnglishAnswer: Reduced ventricular compliance causes diastolic dysfunction, elevated left ventricular filling pressure, and congestion despite preserved systolic ejection.
JapaneseAnswer: 心室コンプライアンス低下による拡張障害で左室充満圧が上昇し、収縮期駆出が保たれていてもうっ血を生じるため。

EnglishQuestion: What is the central hemodynamic problem in acute heart failure?
JapaneseQuestion: 急性心不全の中心的な血行動態異常は？
EnglishAnswer: Abrupt pump failure with insufficient time for compensation, producing low output and venous or pulmonary congestion.
JapaneseAnswer: 代償する時間のない急激なポンプ不全により、低心拍出とうっ血を来す。

EnglishQuestion: Which two clinical axes should always be assessed in acute heart failure?
JapaneseQuestion: 急性心不全で必ず評価する2つの臨床軸は？
EnglishAnswer: Congestion versus no congestion and adequate versus inadequate peripheral perfusion.
JapaneseAnswer: うっ血の有無と、末梢灌流が保たれているか否か。

EnglishQuestion: How does reduced cardiac function create a vicious cycle in acute heart failure?
JapaneseQuestion: 急性心不全で心機能低下はどのように悪循環を作るか？
EnglishAnswer: Reduced cardiac output causes vasoconstriction, increasing cardiac work and oxygen demand, while congestion causes tissue hypoxia; both further worsen cardiac function.
JapaneseAnswer: 心拍出量低下が血管収縮と心仕事量・酸素需要増加を起こし、うっ血が組織低酸素を生じ、両者がさらに心機能を悪化させる。

EnglishQuestion: What are major cardiac precipitants of acute heart failure?
JapaneseQuestion: 急性心不全の主な心臓性誘因は？
EnglishAnswer: Acute coronary syndrome, hypertension, arrhythmia, acute valvular disease, endocarditis, aortic dissection, and cardiomyopathy.
JapaneseAnswer: 急性冠症候群、高血圧、不整脈、急性弁膜症、心内膜炎、大動脈解離、心筋症。

EnglishQuestion: Which noncardiac conditions can precipitate acute heart failure?
JapaneseQuestion: 急性心不全を誘発する非心臓性病態は？
EnglishAnswer: Sepsis, anemia, cardiac tamponade, pulmonary embolism, shunts, and thyrotoxicosis.
JapaneseAnswer: 敗血症、貧血、心タンポナーデ、肺塞栓、シャント、甲状腺中毒症。

EnglishQuestion: How do the congestion findings of left- and right-sided heart failure differ?
JapaneseQuestion: 左心不全と右心不全のうっ血所見はどう異なるか？
EnglishAnswer: Left-sided failure causes pulmonary congestion or edema; right-sided failure causes systemic venous congestion.
JapaneseAnswer: 左心不全は肺うっ血・肺水腫、右心不全は体静脈うっ血を起こす。

EnglishQuestion: What are typical symptoms of left-sided acute heart failure?
JapaneseQuestion: 急性左心不全の典型症状は？
EnglishAnswer: Dyspnea, orthopnea, cardiac asthma, and blood-tinged sputum.
JapaneseAnswer: 呼吸困難、起坐呼吸、心臓喘息、血性痰。

EnglishQuestion: What are typical findings of right-sided heart failure?
JapaneseQuestion: 右心不全の典型所見は？
EnglishAnswer: Peripheral edema, ascites, jugular venous distention, hepatomegaly, and gastrointestinal congestion.
JapaneseAnswer: 末梢浮腫、腹水、頸静脈怒張、肝腫大、消化管うっ血。

EnglishQuestion: What defines cardiogenic shock?
JapaneseQuestion: 心原性ショックの定義は？
EnglishAnswer: Cardiac output is inadequate to maintain blood pressure and organ perfusion, with forward and backward failure occurring together.
JapaneseAnswer: 心拍出量が血圧と臓器灌流を維持できず、前方不全と後方不全が併存する状態。

EnglishQuestion: Which findings indicate end-organ hypoperfusion in cardiogenic shock?
JapaneseQuestion: 心原性ショックで臓器低灌流を示す所見は？
EnglishAnswer: Hypotension, cold extremities, oliguria, altered mental status, and elevated lactate.
JapaneseAnswer: 低血圧、四肢冷感、乏尿、意識障害、乳酸上昇。

EnglishQuestion: What is the preferred initial vasopressor in hypotensive cardiogenic shock?
JapaneseQuestion: 低血圧を伴う心原性ショックの第一選択昇圧薬は？
EnglishAnswer: Norepinephrine to restore perfusion pressure.
JapaneseAnswer: 灌流圧を確保するためのnorepinephrine。

EnglishQuestion: When should an inotrope such as dobutamine be considered in cardiogenic shock?
JapaneseQuestion: 心原性ショックでdobutamineなどの強心薬を検討するのはいつか？
EnglishAnswer: When low cardiac output and hypoperfusion persist despite adequate perfusion pressure and filling.
JapaneseAnswer: 灌流圧と充満が確保されても低心拍出・低灌流が続く場合。

EnglishQuestion: Why is dopamine not the routine first-line vasopressor in cardiogenic shock?
JapaneseQuestion: 心原性ショックでdopamineを第一選択にしない理由は？
EnglishAnswer: It can increase arrhythmias.
JapaneseAnswer: 不整脈を増加させ得るため。

EnglishQuestion: Which tests rapidly identify the cause and severity of acute heart failure?
JapaneseQuestion: 急性心不全の原因と重症度を迅速に評価する検査は？
EnglishAnswer: ECG, troponin and natriuretic peptides, blood gas with lactate, and echocardiography.
JapaneseAnswer: 心電図、troponin・ナトリウム利尿ペプチド、乳酸を含む血液ガス、心エコー。

EnglishQuestion: How are Killip and NYHA classifications used differently?
JapaneseQuestion: Killip分類とNYHA分類はどう使い分けるか？
EnglishAnswer: Killip stratifies acute heart failure complicating acute myocardial infarction; NYHA grades functional limitation in stable chronic heart failure.
JapaneseAnswer: Killip分類は急性心筋梗塞に伴う急性心不全のリスク層別化、NYHA分類は安定期慢性心不全の機能制限評価に用いる。

EnglishQuestion: What are the immediate priorities in acute heart failure treatment?
JapaneseQuestion: 急性心不全治療の初期優先事項は？
EnglishAnswer: Restore oxygenation and tissue perfusion, apply monitoring, obtain IV access, position the patient upright, and assess volume status.
JapaneseAnswer: 酸素化と組織灌流を回復し、monitor装着、静脈路確保、座位、体液量評価を行う。

EnglishQuestion: Which position is generally used initially in acute heart failure?
JapaneseQuestion: 急性心不全で通常まず取らせる体位は？
EnglishAnswer: Sitting upright or at about 45 degrees.
JapaneseAnswer: 座位または約45度の半座位。

EnglishQuestion: What is first-line pharmacologic therapy for congestion in acute heart failure?
JapaneseQuestion: 急性心不全のうっ血に対する第一選択薬は？
EnglishAnswer: An intravenous loop diuretic such as furosemide, adjusted according to urine output, kidney function, and electrolytes.
JapaneseAnswer: furosemideなどの静注loop利尿薬を用い、尿量・腎機能・電解質で調整する。

EnglishQuestion: When are intravenous vasodilators such as nitroglycerin appropriate in acute heart failure?
JapaneseQuestion: 急性心不全でnitroglycerinなどの静注血管拡張薬が適するのはいつか？
EnglishAnswer: When blood pressure is preserved, especially with hypertension or increased afterload.
JapaneseAnswer: 血圧が保たれ、特に高血圧または後負荷増大を伴う場合。

EnglishQuestion: What is the preferred vasopressor for acute heart failure with hypotensive shock?
JapaneseQuestion: 低血圧性shockを伴う急性心不全の第一選択昇圧薬は？
EnglishAnswer: Norepinephrine; epinephrine is reserved for selected rescue situations.
JapaneseAnswer: norepinephrine。epinephrineは選択された救命状況に限る。

EnglishQuestion: When should an inotrope or inodilator be considered in acute heart failure?
JapaneseQuestion: 急性心不全で強心薬または強心性血管拡張薬を検討するのはいつか？
EnglishAnswer: When filling pressure is adequate but low cardiac output and hypoperfusion persist; options include dobutamine, milrinone, or levosimendan.
JapaneseAnswer: 充満圧が十分でも低心拍出・低灌流が続く場合。dobutamine、milrinone、levosimendanなどを用いる。

EnglishQuestion: Should beta-blockers be newly started or up-titrated during acute decompensation?
JapaneseQuestion: 急性増悪中にβ遮断薬を新規開始・増量するか？
EnglishAnswer: No. Start or up-titrate them only after stabilization.
JapaneseAnswer: しない。安定化後に開始・増量する。

EnglishQuestion: Should a chronic beta-blocker be stopped automatically during acute heart failure?
JapaneseQuestion: 急性心不全で慢性内服中のβ遮断薬を自動的に中止するか？
EnglishAnswer: No. Consider dose reduction or temporary withdrawal only for cardiogenic shock, marked hypoperfusion, or symptomatic bradycardia, then reintroduce after stabilization.
JapaneseAnswer: しない。心原性shock、著明な低灌流、症候性徐脈では減量・一時中止を検討し、安定後に再導入する。

EnglishQuestion: What do the bedside terms wet and dry indicate in acute heart failure?
JapaneseQuestion: 急性心不全のbedside分類でwetとdryは何を示すか？
EnglishAnswer: Wet indicates pulmonary or systemic venous congestion; dry indicates no evident congestion.
JapaneseAnswer: wetは肺または体静脈うっ血あり、dryは明らかなうっ血なし。

EnglishQuestion: What do the bedside terms warm and cold indicate in acute heart failure?
JapaneseQuestion: 急性心不全のbedside分類でwarmとcoldは何を示すか？
EnglishAnswer: Warm indicates adequate peripheral perfusion; cold indicates hypoperfusion.
JapaneseAnswer: warmは末梢灌流良好、coldは低灌流。

EnglishQuestion: How is a warm-and-dry acute heart failure profile managed initially?
JapaneseQuestion: warm-dry型急性心不全の初期管理は？
EnglishAnswer: Identify the precipitant and adjust chronic heart failure therapy.
JapaneseAnswer: 誘因を確認し、慢性心不全治療を調整する。

EnglishQuestion: How is a warm-and-wet acute heart failure profile managed initially?
JapaneseQuestion: warm-wet型急性心不全の初期管理は？
EnglishAnswer: Give a loop diuretic and add a vasodilator if blood pressure is preserved, especially when hypertension is present.
JapaneseAnswer: loop利尿薬を投与し、血圧が保たれ高血圧性なら血管拡張薬を追加する。

EnglishQuestion: How is a cold-and-dry acute heart failure profile managed initially?
JapaneseQuestion: cold-dry型急性心不全の初期管理は？
EnglishAnswer: If hypovolemic, give a cautious fluid challenge; if low output persists despite adequate filling, consider an inotrope.
JapaneseAnswer: 低容量なら慎重に輸液し、充満後も低心拍出が続けば強心薬を検討する。

EnglishQuestion: How is a cold-and-wet acute heart failure profile managed initially?
JapaneseQuestion: cold-wet型急性心不全の初期管理は？
EnglishAnswer: Treat shock with a vasopressor or inotrope, relieve congestion, treat the cause in parallel, and consider mechanical circulatory support.
JapaneseAnswer: 昇圧薬・強心薬でshockに対応し、うっ血解除と原因治療を並行し、機械的循環補助を検討する。

EnglishQuestion: Why should therapy not be chosen solely from the warm/cold and wet/dry profile?
JapaneseQuestion: warm/cold・wet/dry分類だけで治療を自動決定してはいけないのはなぜか？
EnglishAnswer: Blood pressure, oxygenation, kidney function, and causes such as acute coronary syndrome, valve disease, and arrhythmia must be evaluated simultaneously.
JapaneseAnswer: 血圧、酸素化、腎機能と、急性冠症候群・弁疾患・不整脈などの原因を同時に評価する必要があるため。

EnglishQuestion: What is chronic heart failure?
JapaneseQuestion: 慢性心不全とは何か？
EnglishAnswer: A clinical syndrome in which cardiac dysfunction causes symptoms and signs while compensatory neurohormonal activation progressively increases cardiac load.
JapaneseAnswer: 心機能障害が症状・徴候を生じ、神経体液性代償が次第に心負荷を増やす臨床症候群。

EnglishQuestion: What are major cardiac causes of chronic heart failure?
JapaneseQuestion: 慢性心不全の主な心臓性原因は？
EnglishAnswer: Ischemic heart disease, cardiomyopathy, hypertension, valvular disease, congenital heart disease, and arrhythmia.
JapaneseAnswer: 虚血性心疾患、心筋症、高血圧、弁膜症、先天性心疾患、不整脈。

EnglishQuestion: Which pulmonary conditions can cause chronic right-sided heart failure?
JapaneseQuestion: 慢性右心不全を起こす肺疾患は？
EnglishAnswer: COPD, pulmonary embolism, and pulmonary hypertension.
JapaneseAnswer: COPD、肺塞栓、肺高血圧。

EnglishQuestion: How does neurohormonal compensation worsen chronic heart failure?
JapaneseQuestion: 神経体液性代償は慢性心不全をどう悪化させるか？
EnglishAnswer: Reduced cardiac output triggers vasoconstriction, raising afterload, cardiac work, and oxygen demand, which promotes hypertrophy, myocardial weakening, and further failure.
JapaneseAnswer: 心拍出量低下が血管収縮を起こし、後負荷・心仕事量・酸素需要を増やして肥大、心筋弱化、さらなる心不全を促す。

EnglishQuestion: How do left- and right-sided chronic heart failure differ in congestion findings?
JapaneseQuestion: 慢性左心不全と右心不全のうっ血所見はどう異なるか？
EnglishAnswer: Left-sided failure causes pulmonary congestion, dyspnea, orthopnea, cough, wheeze, and blood-tinged sputum; right-sided failure causes edema, ascites, raised JVP, hepatomegaly, and GI congestion.
JapaneseAnswer: 左心不全は肺うっ血、呼吸困難、起坐呼吸、咳・喘鳴、血性痰、右心不全は浮腫、腹水、JVP上昇、肝腫大、消化管うっ血を来す。

EnglishQuestion: What can precipitate acute decompensation of chronic heart failure?
JapaneseQuestion: 慢性心不全の急性増悪を誘発するものは？
EnglishAnswer: Cardiac triggers and noncardiac illnesses such as pneumonia.
JapaneseAnswer: 心臓性誘因や肺炎などの非心臓性疾患。

EnglishQuestion: What is the basic diagnostic sequence for suspected chronic heart failure?
JapaneseQuestion: 慢性心不全疑いの基本的診断順序は？
EnglishAnswer: Assess symptoms, signs, risk factors, and ECG; measure BNP or NT-proBNP; if elevated or suspicion remains high, perform echocardiography to assess structure, function, and LVEF.
JapaneseAnswer: 症状・徴候、危険因子、心電図を評価し、BNPまたはNT-proBNPを測定する。高値または疑いが強ければ心エコーで構造・機能・LVEFを評価する。

EnglishQuestion: Which natriuretic peptide thresholds make nonacute heart failure less likely?
JapaneseQuestion: 非急性心不全の可能性を低くするナトリウム利尿ペプチド閾値は？
EnglishAnswer: NT-proBNP below 125 pg/mL or BNP below 35 pg/mL.
JapaneseAnswer: NT-proBNP 125 pg/mL未満またはBNP 35 pg/mL未満。

EnglishQuestion: Why must natriuretic peptide values be interpreted in clinical context?
JapaneseQuestion: ナトリウム利尿ペプチド値を臨床状況と合わせて解釈する理由は？
EnglishAnswer: Atrial fibrillation, kidney dysfunction, and older age can raise them, while obesity can lower them; acute dyspnea also uses higher cutoffs.
JapaneseAnswer: 心房細動、腎機能低下、高齢で上昇し、肥満で低下し得るうえ、急性呼吸困難ではより高いcutoffを用いるため。

EnglishQuestion: How are HFrEF, HFmrEF, and HFpEF classified by LVEF?
JapaneseQuestion: HFrEF、HFmrEF、HFpEFはLVEFでどう分類するか？
EnglishAnswer: HFrEF is 40% or less, HFmrEF is 41-49%, and HFpEF is 50% or more.
JapaneseAnswer: HFrEFは40%以下、HFmrEFは41～49%、HFpEFは50%以上。

EnglishQuestion: What additional evidence is required to diagnose HFpEF?
JapaneseQuestion: HFpEF診断に必要な追加根拠は？
EnglishAnswer: Along with symptoms and signs, objective evidence of diastolic dysfunction, structural abnormality, or elevated filling pressure.
JapaneseAnswer: 症状・徴候に加え、拡張障害、構造異常、充満圧上昇の客観的根拠。

EnglishQuestion: What do NYHA classes I-IV mean?
JapaneseQuestion: NYHA I～IV度は何を表すか？
EnglishAnswer: I: no symptoms with ordinary activity; II: mild limitation; III: marked limitation with less-than-ordinary activity; IV: symptoms at rest and inability to exercise without discomfort.
JapaneseAnswer: I度は通常活動で無症状、II度は軽度制限、III度は通常未満の活動で症状を伴う高度制限、IV度は安静時にも症状があり身体活動不能。

EnglishQuestion: How do NYHA and Killip classifications differ?
JapaneseQuestion: NYHA分類とKillip分類はどう異なるか？
EnglishAnswer: NYHA grades functional limitation in chronic heart failure; Killip stratifies acute heart failure complicating acute myocardial infarction.
JapaneseAnswer: NYHAは慢性心不全の機能制限、Killipは急性心筋梗塞に伴う急性心不全のリスクを分類する。

EnglishQuestion: What is the typical illness trajectory of chronic heart failure?
JapaneseQuestion: 慢性心不全の典型的な時間経過は？
EnglishAnswer: Stable periods are interrupted by acute decompensations; recovery may reach a lower baseline each time, and exacerbations become more frequent in advanced disease.
JapaneseAnswer: 安定期に急性増悪が反復し、回復しても以前より低いbaselineとなり、進行例では増悪間隔が短くなる。

EnglishQuestion: What are the distinct diagnostic roles of echocardiography and natriuretic peptides in chronic heart failure?
JapaneseQuestion: 慢性心不全診断で心エコーとナトリウム利尿ペプチドの役割はどう異なるか？
EnglishAnswer: Echocardiography directly assesses structural and functional abnormalities; natriuretic peptides reflect myocardial wall stretch.
JapaneseAnswer: 心エコーは構造・機能異常を直接評価し、ナトリウム利尿ペプチドは心筋壁伸展を反映する。

EnglishQuestion: What are the major goals of chronic heart failure treatment?
JapaneseQuestion: 慢性心不全治療の主な目標は？
EnglishAnswer: Reduce mortality, relieve symptoms and morbidity, limit myocardial injury and remodeling, and prevent decompensation and hospitalization.
JapaneseAnswer: 死亡を減らし、症状・罹病負担を軽減し、心筋障害・remodelingを抑え、再増悪・入院を予防する。

EnglishQuestion: What are the four foundational drug classes for HFrEF?
JapaneseQuestion: HFrEFの基本4本柱となる薬剤は？
EnglishAnswer: An ARNI or, if unavailable, an ACE inhibitor or ARB; an evidence-based beta-blocker; a mineralocorticoid receptor antagonist; and an SGLT2 inhibitor.
JapaneseAnswer: ARNIまたは使用不可ならACE阻害薬・ARB、エビデンスのあるβ遮断薬、MRA、SGLT2阻害薬。

EnglishQuestion: How should the four foundational HFrEF therapies be introduced?
JapaneseQuestion: HFrEFの基本4薬はどのように導入するか？
EnglishAnswer: Introduce them early and titrate as tolerated rather than waiting to maximize one drug before starting the others.
JapaneseAnswer: 1剤の最大化を待たず、忍容性を確認しながら早期に導入・増量する。

EnglishQuestion: Which beta-blockers have established evidence in HFrEF?
JapaneseQuestion: HFrEFでエビデンスのあるβ遮断薬は？
EnglishAnswer: Bisoprolol, metoprolol succinate, and carvedilol.
JapaneseAnswer: ビソプロロール、メトプロロール徐放製剤、カルベジロール。

EnglishQuestion: Which drugs are mineralocorticoid receptor antagonists used in HFrEF?
JapaneseQuestion: HFrEFで用いるMRAは？
EnglishAnswer: Spironolactone and eplerenone.
JapaneseAnswer: spironolactoneとeplerenone。

EnglishQuestion: What is the role of mineralocorticoid receptor antagonists in HFrEF?
JapaneseQuestion: HFrEFにおけるMRAの役割は？
EnglishAnswer: They block aldosterone and reduce myocardial fibrosis and arrhythmia risk.
JapaneseAnswer: aldosteroneを遮断し、心筋線維化と不整脈リスクを抑える。

EnglishQuestion: What is the main role of loop diuretics in chronic heart failure?
JapaneseQuestion: 慢性心不全におけるloop利尿薬の主な役割は？
EnglishAnswer: Relieve congestion and fluid accumulation; they primarily improve symptoms rather than replace disease-modifying therapy.
JapaneseAnswer: うっ血と体液貯留を軽減する。疾患修飾療法の代替ではなく、主に症状を改善する。

EnglishQuestion: What is digoxin used for in chronic heart failure?
JapaneseQuestion: 慢性心不全でdigoxinは何に用いるか？
EnglishAnswer: Rate control of supraventricular arrhythmias in selected patients.
JapaneseAnswer: 選択例における上室性不整脈の心拍数調節。

EnglishQuestion: Why should verapamil and diltiazem be avoided in HFrEF?
JapaneseQuestion: HFrEFでverapamilとdiltiazemを避ける理由は？
EnglishAnswer: Their negative inotropic effect can worsen heart failure.
JapaneseAnswer: 陰性変力作用により心不全を悪化させ得るため。

EnglishQuestion: What is the purpose of an implantable cardioverter-defibrillator in HFrEF?
JapaneseQuestion: HFrEFにおけるICDの目的は？
EnglishAnswer: Prevention of sudden cardiac death from malignant ventricular arrhythmias.
JapaneseAnswer: 致死性心室性不整脈による突然心臓死の予防。

EnglishQuestion: Which factors are integrated when considering a primary-prevention ICD?
JapaneseQuestion: 一次予防ICDの適応判断で統合する因子は？
EnglishAnswer: Ischemic versus nonischemic etiology, LVEF after adequate guideline-directed therapy, timing after myocardial infarction, comorbidities, and expected survival beyond 1 year.
JapaneseAnswer: 虚血性・非虚血性の病因、十分なGDMT後のLVEF、心筋梗塞後の時期、併存疾患、1年超の予測生存。

EnglishQuestion: When is a standard dual-chamber pacemaker used in a patient with heart failure?
JapaneseQuestion: 心不全患者で通常のdual-chamber pacemakerを用いるのはいつか？
EnglishAnswer: For a pacing indication such as symptomatic bradycardia or atrioventricular block, not merely for a low LVEF or high NYHA class.
JapaneseAnswer: 症候性徐脈や房室blockなどのpacing適応がある場合で、LVEF低下やNYHA classだけでは適応にしない。

EnglishQuestion: What is the purpose of cardiac resynchronization therapy?
JapaneseQuestion: CRTの目的は？
EnglishAnswer: Correct ventricular electrical and mechanical dyssynchrony in appropriately selected heart failure patients.
JapaneseAnswer: 適切な心不全患者で心室の電気的・機械的dyssynchronyを補正する。

EnglishQuestion: Which profile derives the greatest benefit from cardiac resynchronization therapy?
JapaneseQuestion: CRTの利益が特に大きい患者像は？
EnglishAnswer: Persistent symptoms despite adequate therapy, LVEF at or below 35%, and prolonged QRS, especially left bundle branch block with QRS at least 150 ms.
JapaneseAnswer: 十分な治療後も症候性、LVEF 35%以下、QRS延長があり、特にLBBBかつQRS 150 ms以上。

EnglishQuestion: Which lifestyle measures support chronic heart failure treatment?
JapaneseQuestion: 慢性心不全治療を支える生活習慣介入は？
EnglishAnswer: Appropriate physical activity, dietary improvement, weight reduction when needed, sodium and fluid restriction, alcohol limitation, and smoking cessation.
JapaneseAnswer: 適切な運動、食事改善、必要時減量、食塩・水分制限、飲酒制限、禁煙。

EnglishQuestion: What three major pathologic consequences arise from infective endocarditis vegetation?
JapaneseQuestion: 感染性心内膜炎の疣贅から生じる3つの主要病態は？
EnglishAnswer: Valve destruction, septic embolization, and immune-complex injury.
JapaneseAnswer: 弁破壊、敗血症性塞栓、免疫複合体障害。

EnglishQuestion: What components make up an infective endocarditis vegetation?
JapaneseQuestion: 感染性心内膜炎の疣贅を構成するものは？
EnglishAnswer: Necrotic tissue, cellular debris, fibrin, inflammatory cells, platelets, and microorganisms.
JapaneseAnswer: 壊死組織、細胞残渣、fibrin、炎症細胞、血小板、病原体。

EnglishQuestion: Which organism is most typical of acute infective endocarditis, and how does it behave?
JapaneseQuestion: 急性感染性心内膜炎に最も典型的な病原体と特徴は？
EnglishAnswer: Staphylococcus aureus; it can infect normal valves and destroy them rapidly.
JapaneseAnswer: Staphylococcus aureusで、正常弁にも感染し急速に破壊し得る。

EnglishQuestion: Which organism is most typical of subacute infective endocarditis?
JapaneseQuestion: 亜急性感染性心内膜炎に最も典型的な病原体は？
EnglishAnswer: Viridans streptococci, usually on a previously damaged valve and sometimes after dental procedures.
JapaneseAnswer: viridans streptococciで、通常は既存障害弁に感染し、歯科処置後と関連し得る。

EnglishQuestion: Which exposures increase the risk of infective endocarditis?
JapaneseQuestion: 感染性心内膜炎リスクを高める曝露は？
EnglishAnswer: Hemodialysis catheters, permanent cardiac devices, prosthetic valves, and intravenous drug use.
JapaneseAnswer: 透析catheter、恒久的心臓device、人工弁、静注薬物使用。

EnglishQuestion: How does infective endocarditis progress from bacteremia to systemic complications?
JapaneseQuestion: 感染性心内膜炎は菌血症から全身合併症へどう進むか？
EnglishAnswer: Bacteremia seeds susceptible endocardium and forms friable vegetation, causing valve destruction, fragmentation with septic emboli, and immune-complex formation.
JapaneseAnswer: 菌血症が感受性心内膜に定着して脆い疣贅を形成し、弁破壊、破砕による敗血症性塞栓、免疫複合体形成を起こす。

EnglishQuestion: How do Janeway lesions and Osler nodes differ?
JapaneseQuestion: Janeway lesionとOsler nodeはどう異なるか？
EnglishAnswer: Janeway lesions are painless palm or sole lesions from septic microemboli; Osler nodes are painful digital nodules from immune-complex deposition.
JapaneseAnswer: Janeway lesionは敗血症性微小塞栓による無痛性手掌・足底病変、Osler nodeは免疫複合体沈着による有痛性手足結節。

EnglishQuestion: Which presentation should strongly raise suspicion for infective endocarditis in fever of unknown origin?
JapaneseQuestion: 不明熱で感染性心内膜炎を強く疑う所見は？
EnglishAnswer: New atrioventricular block, new heart failure, a peripheral abscess, previous endocarditis, or intracardiac foreign material.
JapaneseAnswer: 新規房室block、新規心不全、末梢膿瘍、心内膜炎既往、心内異物。

EnglishQuestion: What are the two pillars of the major Duke criteria?
JapaneseQuestion: Duke基準のmajor criteriaを構成する2本柱は？
EnglishAnswer: Positive blood cultures with a typical or persistent pattern and evidence of endocardial involvement on imaging or new valvular regurgitation.
JapaneseAnswer: 典型的または持続性の血液培養陽性と、画像上の心内膜病変または新規弁逆流。

EnglishQuestion: What are the minor Duke criteria?
JapaneseQuestion: Duke基準のminor criteriaは？
EnglishAnswer: Predisposition, fever above 38°C, vascular phenomena, immunologic phenomena, and microbiologic evidence not meeting a major criterion.
JapaneseAnswer: 素因、38℃超の発熱、血管現象、免疫現象、majorを満たさない微生物学的所見。

EnglishQuestion: Which Duke combinations define definite infective endocarditis?
JapaneseQuestion: Duke基準でdefinite IEとなる組合せは？
EnglishAnswer: Two major criteria, one major plus three minor criteria, or five minor criteria.
JapaneseAnswer: major 2つ、major 1つ＋minor 3つ、またはminor 5つ。

EnglishQuestion: How should suspected infective endocarditis be reassessed after initially negative or inconclusive tests?
JapaneseQuestion: 初回検査が陰性・不確定でもIE疑いが強い場合の再評価は？
EnglishAnswer: Repeat adequate blood cultures and TTE or TEE; add cardiac CT for perivalvular disease and selected PET/CT or leukocyte imaging for prosthetic valve or device infection.
JapaneseAnswer: 十分な血液培養とTTE／TEEを反復し、傍弁病変には心臓CT、人工弁・device感染には選択的にPET/CT等を追加する。

EnglishQuestion: When should antibiotics be started in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で抗菌薬を開始する時点は？
EnglishAnswer: After obtaining appropriate blood cultures, start intravenous therapy tailored to organism, susceptibility, valve type, and complications.
JapaneseAnswer: 適切な血液培養採取後、病原体、感受性、弁の種類、合併症に合わせて静注治療を開始する。

EnglishQuestion: Which findings support early surgery in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で早期手術を支持する所見は？
EnglishAnswer: Prosthetic valve infection, severe valve dysfunction or heart failure, uncontrolled infection, abscess or new conduction disturbance, and high embolic risk.
JapaneseAnswer: 人工弁感染、重症弁機能障害・心不全、制御不能感染、膿瘍・新規伝導障害、塞栓高リスク。

EnglishQuestion: For whom is antibiotic prophylaxis against infective endocarditis generally reserved?
JapaneseQuestion: 感染性心内膜炎の抗菌薬予防は原則誰に限定するか？
EnglishAnswer: Patients with high-risk cardiac conditions undergoing high-risk dental procedures, rather than routine prophylaxis for broad categories of procedures.
JapaneseAnswer: 高リスク心疾患患者が高リスク歯科処置を受ける場合で、広範な処置へのroutine予防は行わない。

EnglishQuestion: What is the difference between pericarditis and pericardial effusion?
JapaneseQuestion: 心膜炎と心嚢液貯留の違いは？
EnglishAnswer: Pericarditis is inflammation of the pericardium; pericardial effusion is fluid accumulation in the pericardial space.
JapaneseAnswer: 心膜炎は心膜の炎症、心嚢液貯留は心膜腔への液体蓄積。

EnglishQuestion: Which systemic diseases can cause secondary pericarditis?
JapaneseQuestion: 二次性心膜炎を起こす全身疾患は？
EnglishAnswer: Uremia, rheumatic fever, bacteremia, tuberculosis, systemic lupus erythematosus, and malignancy.
JapaneseAnswer: 尿毒症、リウマチ熱、菌血症、結核、SLE、悪性腫瘍。

EnglishQuestion: Which local conditions can cause secondary pericarditis?
JapaneseQuestion: 二次性心膜炎を起こす局所病態は？
EnglishAnswer: Myocardial infarction, cardiac surgery, irradiation, and aortic dissection.
JapaneseAnswer: 心筋梗塞、心臓手術、放射線照射、大動脈解離。

EnglishQuestion: What is the characteristic chest pain pattern of acute pericarditis?
JapaneseQuestion: 急性心膜炎に特徴的な胸痛は？
EnglishAnswer: Pleuritic pain that worsens with inspiration and lying supine and improves when sitting forward.
JapaneseAnswer: 吸気・仰臥位で悪化し、座位前屈で軽快する胸膜炎様胸痛。

EnglishQuestion: What causes a pericardial friction rub?
JapaneseQuestion: 心膜摩擦音は何によって生じるか？
EnglishAnswer: Friction between inflamed visceral and parietal pericardial surfaces.
JapaneseAnswer: 炎症を起こした臓側・壁側心膜の摩擦。

EnglishQuestion: What is the characteristic ECG pattern of acute pericarditis?
JapaneseQuestion: 急性心膜炎の特徴的心電図所見は？
EnglishAnswer: Diffuse concave or saddle-shaped ST elevation without reciprocal changes.
JapaneseAnswer: 鏡像変化を伴わない多誘導の凹型・鞍型ST上昇。

EnglishQuestion: Which ECG findings suggest a large pericardial effusion?
JapaneseQuestion: 大量心嚢液を示唆する心電図所見は？
EnglishAnswer: Low-voltage QRS complexes and electrical alternans.
JapaneseAnswer: 低電位QRSと電気的交互脈。

EnglishQuestion: What is the echocardiographic appearance of pericardial effusion?
JapaneseQuestion: 心嚢液貯留の心エコー所見は？
EnglishAnswer: An echo-free space surrounding the heart.
JapaneseAnswer: 心臓周囲のecho-free space。

EnglishQuestion: How does pericardial effusion progress to cardiac tamponade?
JapaneseQuestion: 心嚢液貯留はどのように心タンポナーデへ進むか？
EnglishAnswer: Rising intrapericardial pressure compresses the heart, causes right atrial and ventricular diastolic collapse, reduces filling and cardiac output, and produces hypotension or shock.
JapaneseAnswer: 心嚢内圧上昇が心臓を圧迫し、右房・右室拡張期虚脱、充満・心拍出量低下を経て低血圧・shockを起こす。

EnglishQuestion: What is Beck triad in cardiac tamponade?
JapaneseQuestion: 心タンポナーデのBeck三徴は？
EnglishAnswer: Hypotension, elevated jugular venous pressure, and muffled heart sounds.
JapaneseAnswer: 低血圧、頸静脈圧上昇、心音減弱。

EnglishQuestion: Which additional bedside findings suggest cardiac tamponade?
JapaneseQuestion: 心タンポナーデを示唆する追加bedside所見は？
EnglishAnswer: Tachycardia and pulsus paradoxus.
JapaneseAnswer: 頻脈と奇脈。

EnglishQuestion: Which echocardiographic findings support cardiac tamponade?
JapaneseQuestion: 心タンポナーデを支持する心エコー所見は？
EnglishAnswer: Pericardial effusion, right atrial systolic collapse, right ventricular early-diastolic collapse, and exaggerated respiratory flow variation.
JapaneseAnswer: 心嚢液、右房収縮期虚脱、右室拡張早期虚脱、呼吸性血流変動増大。

EnglishQuestion: Why can a relatively small pericardial effusion cause tamponade?
JapaneseQuestion: 比較的少量の心嚢液でもタンポナーデを起こすのはなぜか？
EnglishAnswer: Risk depends strongly on the rate of accumulation; rapid accumulation of about 250 mL may critically raise intrapericardial pressure.
JapaneseAnswer: 危険度は貯留速度に強く依存し、約250 mLでも急速なら心嚢内圧を危険に上昇させるため。

EnglishQuestion: What is first-line anti-inflammatory treatment for uncomplicated acute pericarditis?
JapaneseQuestion: 合併症のない急性心膜炎の第一選択抗炎症治療は？
EnglishAnswer: Aspirin or an NSAID plus colchicine.
JapaneseAnswer: aspirinまたはNSAIDにcolchicineを併用する。

EnglishQuestion: What is the emergency treatment of cardiac tamponade?
JapaneseQuestion: 心タンポナーデの緊急治療は？
EnglishAnswer: Immediate ultrasound-guided pericardiocentesis.
JapaneseAnswer: 直ちに超音波ガイド下心嚢穿刺を行う。

EnglishQuestion: How do aortic stenosis and aortic regurgitation differ in ventricular loading and hypertrophy?
JapaneseQuestion: 大動脈弁狭窄と逆流は左室負荷・肥大がどう異なるか？
EnglishAnswer: Aortic stenosis causes pressure overload and concentric hypertrophy; aortic regurgitation causes volume overload and eccentric hypertrophy.
JapaneseAnswer: 大動脈弁狭窄は圧負荷・求心性肥大、逆流は容量負荷・偏心性肥大を起こす。

EnglishQuestion: What valve area defines severe aortic stenosis?
JapaneseQuestion: 重症大動脈弁狭窄を定義する弁口面積は？
EnglishAnswer: Less than 1.0 cm²; normal is above 2.5 cm².
JapaneseAnswer: 1.0 cm²未満。正常は2.5 cm²超。

EnglishQuestion: How does aortic stenosis progress to systolic dysfunction?
JapaneseQuestion: 大動脈弁狭窄はどのように収縮機能障害へ進むか？
EnglishAnswer: Pressure overload causes concentric LV hypertrophy, increased oxygen demand and reduced compliance, then increased filling pressure, reduced stroke volume and cardiac output, and finally LV systolic dysfunction.
JapaneseAnswer: 圧負荷が左室求心性肥大、酸素需要増加、compliance低下を起こし、充満圧上昇、SV・CO低下を経て左室収縮不全へ進む。

EnglishQuestion: What are the major acquired and congenital causes of aortic stenosis?
JapaneseQuestion: 大動脈弁狭窄の主な後天性・先天性原因は？
EnglishAnswer: Acquired causes are degenerative calcification and rheumatic disease; congenital causes are bicuspid or unicuspid aortic valves.
JapaneseAnswer: 後天性は変性石灰化とリウマチ性、先天性は二尖弁・一尖弁。

EnglishQuestion: What is the classic symptom triad of aortic stenosis?
JapaneseQuestion: 大動脈弁狭窄の典型的三主徴は？
EnglishAnswer: Dyspnea, angina, and syncope.
JapaneseAnswer: 呼吸困難、狭心症、失神。

EnglishQuestion: What are the classic pulse and auscultatory findings of aortic stenosis?
JapaneseQuestion: 大動脈弁狭窄の典型的脈拍・聴診所見は？
EnglishAnswer: Pulsus parvus et tardus, narrow pulse pressure, and a midsystolic crescendo-decrescendo murmur radiating to the carotids.
JapaneseAnswer: 遅く弱い脈、脈圧狭小、頸動脈へ放散する収縮中期漸増漸減雑音。

EnglishQuestion: Which Doppler velocity supports severe aortic stenosis?
JapaneseQuestion: 重症大動脈弁狭窄を支持するDoppler流速は？
EnglishAnswer: An aortic jet velocity of about 4 m/s, compared with a normal 1-1.5 m/s.
JapaneseAnswer: 大動脈弁通過速度約4 m/s。正常は1～1.5 m/s。

EnglishQuestion: How do degenerative, bicuspid, and rheumatic aortic stenosis differ morphologically?
JapaneseQuestion: 変性、二尖弁、リウマチ性大動脈弁狭窄は形態がどう異なるか？
EnglishAnswer: Degenerative disease has irregular leaflet calcification; a bicuspid valve has two cusps and an oval opening; rheumatic disease has commissural fusion with a small central opening.
JapaneseAnswer: 変性型は不整な弁石灰化、二尖弁は2枚の弁尖と楕円形開口、リウマチ性は交連癒合と小さな中央開口。

EnglishQuestion: What is the definitive treatment for symptomatic severe aortic stenosis?
JapaneseQuestion: 症候性重症大動脈弁狭窄の根治治療は？
EnglishAnswer: Aortic valve replacement by SAVR or TAVI.
JapaneseAnswer: SAVRまたはTAVIによる大動脈弁置換。

EnglishQuestion: How are SAVR and TAVI selected?
JapaneseQuestion: SAVRとTAVIはどのように選択するか？
EnglishAnswer: A Heart Team integrates age, life expectancy, anatomy, access route, frailty, surgical risk, need for concomitant surgery, durability, and patient preference.
JapaneseAnswer: Heart Teamが年齢、余命、解剖、アクセス、frailty、手術リスク、併施手術、耐久性、患者希望を統合する。

EnglishQuestion: What is the sequence of TAVI deployment?
JapaneseQuestion: TAVI施行の流れは？
EnglishAnswer: Advance the folded bioprosthesis to the native valve, deploy it across the annulus to displace the stenotic cusps, then confirm forward flow and exclude paravalvular leak and coronary obstruction.
JapaneseAnswer: 折り畳んだ生体弁を自己弁まで進め、弁輪をまたいで展開し、順行性血流を確認して弁周囲逆流・冠閉塞を除外する。

EnglishQuestion: How does chronic aortic regurgitation progress to heart failure?
JapaneseQuestion: 慢性大動脈弁逆流はどのように心不全へ進むか？
EnglishAnswer: Volume overload increases LV end-diastolic volume and stroke volume, followed by LV dilation, eccentric hypertrophy, myocyte dysfunction, and LV failure.
JapaneseAnswer: 容量負荷が左室拡張末期容量・一回拍出量を増やし、左室拡張、偏心性肥大、心筋機能障害、左室不全へ進む。

EnglishQuestion: How do acute and chronic aortic regurgitation differ in causes and course?
JapaneseQuestion: 急性と慢性の大動脈弁逆流は原因・経過がどう異なるか？
EnglishAnswer: Acute AR commonly results from endocarditis, dissection, or trauma and rapidly causes pulmonary edema; chronic AR develops slowly from rheumatic, connective-tissue, degenerative, congenital, or aortic disease.
JapaneseAnswer: 急性ARは心内膜炎、解離、外傷で急速に肺水腫を起こす。慢性ARはリウマチ性、結合組織、変性、先天性、大動脈疾患から緩徐に進む。

EnglishQuestion: What findings indicate intervention for aortic regurgitation?
JapaneseQuestion: 大動脈弁逆流の介入適応となる所見は？
EnglishAnswer: Symptoms, LV dilation, or LV dysfunction indicate valve repair or replacement.
JapaneseAnswer: 症状、左室拡張、左室機能障害があれば弁形成または置換を行う。

EnglishQuestion: What is the fundamental hemodynamic difference between mitral stenosis and mitral regurgitation?
JapaneseQuestion: 僧帽弁狭窄と逆流の基本的な血行動態の違いは？
EnglishAnswer: Mitral stenosis obstructs flow from the left atrium to the left ventricle; mitral regurgitation causes systolic volume flow from the left ventricle back to the left atrium.
JapaneseAnswer: 僧帽弁狭窄は左房から左室への流入を障害し、逆流は収縮期に左室から左房へ容量を戻す。

EnglishQuestion: What is the most important cause of mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄の最重要原因は？
EnglishAnswer: Rheumatic fever following Streptococcus pyogenes infection.
JapaneseAnswer: Streptococcus pyogenes感染後のリウマチ熱。

EnglishQuestion: How does mitral stenosis progress to pulmonary hypertension and embolism?
JapaneseQuestion: 僧帽弁狭窄はどのように肺高血圧と塞栓へ進むか？
EnglishAnswer: Reduced valve area raises left atrial pressure and causes dilation, leading to pulmonary hypertension and to atrial fibrillation with left atrial thrombus and systemic embolism.
JapaneseAnswer: 弁口面積低下が左房圧上昇・拡張を起こし、肺高血圧と、心房細動・左房血栓による全身塞栓へ進む。

EnglishQuestion: What are the typical symptoms of mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄の典型症状は？
EnglishAnswer: Dyspnea, hemoptysis, and systemic or cerebral embolization.
JapaneseAnswer: 呼吸困難、喀血、全身・脳塞栓。

EnglishQuestion: Which ECG findings are typical of advanced mitral stenosis?
JapaneseQuestion: 進行した僧帽弁狭窄の典型的心電図所見は？
EnglishAnswer: Atrial fibrillation, P mitrale, right ventricular hypertrophy, right-axis deviation, and a tall R wave in V1.
JapaneseAnswer: 心房細動、P mitrale、右室肥大、右軸偏位、V1の高いR波。

EnglishQuestion: How is atrial fibrillation managed in mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄に伴う心房細動をどう管理するか？
EnglishAnswer: Use a beta-blocker, calcium-channel blocker, or digoxin for rate control and provide anticoagulation.
JapaneseAnswer: β遮断薬、Ca拮抗薬、digoxinで心拍数を調節し、抗凝固療法を行う。

EnglishQuestion: When is percutaneous mitral commissurotomy considered?
JapaneseQuestion: 経皮的僧帽弁交連切開術を検討するのはいつか？
EnglishAnswer: For clinically significant stenosis with valve area at or below 1.5 cm² when valve and subvalvular anatomy are suitable and significant MR or left atrial thrombus is absent.
JapaneseAnswer: 弁口面積1.5 cm²以下で、弁・弁下形態が適し、重症MRや左房血栓がない場合。

EnglishQuestion: How do organic and functional mitral regurgitation differ?
JapaneseQuestion: 器質性MRと機能性MRはどう異なるか？
EnglishAnswer: Organic MR results from anatomic valve or subvalvular lesions; functional MR results mainly from ventricular, atrial, or annular remodeling.
JapaneseAnswer: 器質性MRは弁・弁下構造の解剖学的病変、機能性MRは主に心室・心房・弁輪remodelingによる。

EnglishQuestion: What are important causes of acute mitral regurgitation?
JapaneseQuestion: 急性僧帽弁逆流の重要な原因は？
EnglishAnswer: Chordal rupture, papillary muscle rupture after acute myocardial infarction, and infective endocarditis.
JapaneseAnswer: 腱索断裂、急性心筋梗塞後の乳頭筋断裂、感染性心内膜炎。

EnglishQuestion: Why does acute severe mitral regurgitation cause pulmonary edema and shock without marked chamber enlargement?
JapaneseQuestion: 急性重症MRで心腔拡大が乏しくても肺水腫・shockを起こすのはなぜか？
EnglishAnswer: A non-dilated, poorly compliant left atrium cannot accommodate the sudden regurgitant volume, so left atrial pressure rises abruptly.
JapaneseAnswer: 拡張しておらずcomplianceの低い左房が急な逆流量を受け止められず、左房圧が急上昇するため。

EnglishQuestion: How does chronic mitral regurgitation progress to heart failure?
JapaneseQuestion: 慢性僧帽弁逆流はどのように心不全へ進むか？
EnglishAnswer: Volume overload causes left atrial and ventricular dilation and eccentric hypertrophy, followed by rising filling pressure, reduced contractility, pulmonary hypertension, and right ventricular failure.
JapaneseAnswer: 容量負荷が左房・左室拡張と偏心性肥大を起こし、充満圧上昇、収縮力低下、肺高血圧、右室不全へ進む。

EnglishQuestion: Which LV thresholds indicate surgery in asymptomatic severe primary mitral regurgitation?
JapaneseQuestion: 無症候性重症一次性MRの手術適応となる左室基準は？
EnglishAnswer: LVEF at or below 60% or LV end-systolic diameter at or above 40 mm.
JapaneseAnswer: LVEF 60%以下または左室収縮末期径40 mm以上。

EnglishQuestion: What additional findings support early intervention in severe primary mitral regurgitation?
JapaneseQuestion: 重症一次性MRで早期介入を支持する追加所見は？
EnglishAnswer: New atrial fibrillation or resting pulmonary artery systolic pressure above 50 mmHg; durable repair is preferred over replacement when feasible.
JapaneseAnswer: 新規心房細動または安静時肺動脈収縮期圧50 mmHg超。可能なら耐久性のある弁形成を置換より優先する。

EnglishQuestion: How does Eisenmenger syndrome develop from a congenital left-to-right shunt?
JapaneseQuestion: 先天性左右shuntからEisenmenger症候群はどう成立するか？
EnglishAnswer: Chronic increased pulmonary flow raises pulmonary vascular resistance until pulmonary pressure exceeds systemic pressure and the shunt reverses right-to-left.
JapaneseAnswer: 長期の肺血流増加で肺血管抵抗が上昇し、肺動脈圧が体血圧を超えるとshuntが右左へ反転する。

EnglishQuestion: What is the most common type of atrial septal defect?
JapaneseQuestion: 最も多い心房中隔欠損型は？
EnglishAnswer: Ostium secundum ASD.
JapaneseAnswer: 二次孔型ASD。

EnglishQuestion: What are the classic auscultatory findings of an atrial septal defect?
JapaneseQuestion: ASDの典型的聴診所見は？
EnglishAnswer: An ejection systolic murmur with fixed splitting of S2 that does not vary with respiration.
JapaneseAnswer: 駆出性収縮期雑音と、呼吸で変化しないS2固定性分裂。

EnglishQuestion: How do secundum and primum atrial septal defects differ in ECG axis?
JapaneseQuestion: 二次孔型と一次孔型ASDは心電図軸がどう異なるか？
EnglishAnswer: Secundum ASD commonly causes right-axis deviation; primum ASD causes left-axis deviation.
JapaneseAnswer: 二次孔型は右軸偏位、一次孔型は左軸偏位を来しやすい。

EnglishQuestion: What is the usual hemodynamic significance of a patent foramen ovale?
JapaneseQuestion: PFOの通常の血行動態的影響は？
EnglishAnswer: It usually has little major hemodynamic effect, but transient right-to-left flow can permit paradoxical embolism.
JapaneseAnswer: 通常は大きな血行動態的影響はないが、一過性右左shuntで奇異性塞栓を起こし得る。

EnglishQuestion: What is the usual postnatal shunt direction through a ventricular septal defect?
JapaneseQuestion: 出生後VSDの通常のshunt方向は？
EnglishAnswer: From the left ventricle to the right ventricle and pulmonary circulation.
JapaneseAnswer: 左室から右室、肺循環への左右shunt。

EnglishQuestion: How does a large VSD progress to Eisenmenger syndrome?
JapaneseQuestion: 大きなVSDはどうEisenmenger症候群へ進むか？
EnglishAnswer: Left-to-right flow causes RV volume overload and pulmonary hypertension; rising pulmonary vascular resistance eventually reverses flow to right-to-left.
JapaneseAnswer: 左右shuntが右室容量負荷と肺高血圧を起こし、肺血管抵抗上昇により最終的に右左shuntへ反転する。

EnglishQuestion: What is the postnatal shunt direction in patent ductus arteriosus?
JapaneseQuestion: 出生後PDAのshunt方向は？
EnglishAnswer: From the aorta to the pulmonary artery.
JapaneseAnswer: 大動脈から肺動脈への左右shunt。

EnglishQuestion: What are the four components of tetralogy of Fallot?
JapaneseQuestion: Fallot四徴症の4徴は？
EnglishAnswer: Ventricular septal defect, overriding aorta, right ventricular outflow tract obstruction or pulmonary stenosis, and right ventricular hypertrophy.
JapaneseAnswer: VSD、大動脈騎乗、右室流出路狭窄・肺動脈弁狭窄、右室肥大。

EnglishQuestion: What determines the degree of cyanosis in tetralogy of Fallot?
JapaneseQuestion: Fallot四徴症のcyanosis程度を決めるものは？
EnglishAnswer: The severity of right ventricular outflow obstruction; greater obstruction increases right-to-left flow through the VSD.
JapaneseAnswer: 右室流出路狭窄の強さ。狭窄が強いほどVSDを介する右左shuntが増える。

EnglishQuestion: What are the characteristic circulation and survival requirement in complete transposition of the great arteries?
JapaneseQuestion: 完全大血管転位の循環様式と生存条件は？
EnglishAnswer: The aorta arises from the RV and pulmonary artery from the LV, creating parallel circulations; survival requires mixing through an ASD, VSD, or PDA.
JapaneseAnswer: 大動脈が右室、肺動脈が左室から起始して並列循環となり、ASD・VSD・PDAなどによる血液混合が生存に必須。

EnglishQuestion: How do preductal and postductal coarctation of the aorta differ?
JapaneseQuestion: 大動脈縮窄の管前型と管後型はどう異なるか？
EnglishAnswer: Preductal disease is duct-dependent and can cause lower-body cyanosis; postductal disease causes upper-limb hypertension, lower-limb hypotension, and collateral flow.
JapaneseAnswer: 管前型は動脈管依存性で下半身cyanosisを来し得る。管後型は上肢高血圧、下肢低血圧、側副血行を生じる。

EnglishQuestion: What are the classic physical findings of adult coarctation of the aorta?
JapaneseQuestion: 成人型大動脈縮窄の典型的身体所見は？
EnglishAnswer: Brachial-femoral pulse delay, weak femoral pulses, upper-to-lower limb blood pressure difference, and a scapular collateral murmur.
JapaneseAnswer: 上腕－大腿動脈脈波遅延、弱い大腿動脈拍動、上下肢血圧差、肩甲部側副血行雑音。

EnglishQuestion: What is the key anatomic abnormality in Ebstein anomaly?
JapaneseQuestion: Ebstein奇形の主要解剖異常は？
EnglishAnswer: Apical displacement of the tricuspid valve, creating an atrialized portion of the right ventricle and a small functional RV.
JapaneseAnswer: 三尖弁の心尖側偏位により、右室の心房化と機能的右室腔縮小を生じる。

EnglishQuestion: Why is early closure of a significant congenital left-to-right shunt important?
JapaneseQuestion: 有意な先天性左右shuntを早期閉鎖することが重要なのはなぜか？
EnglishAnswer: To prevent irreversible pulmonary vascular disease and Eisenmenger physiology.
JapaneseAnswer: 不可逆的肺血管病変とEisenmenger化を防ぐため。

EnglishQuestion: What two hemodynamic variables determine arterial blood pressure?
JapaneseQuestion: 動脈血圧を決める2つの血行動態変数は？
EnglishAnswer: Blood pressure equals cardiac output multiplied by total peripheral resistance.
JapaneseAnswer: 血圧は心拍出量×総末梢血管抵抗で決まる。

EnglishQuestion: What office blood pressure threshold traditionally defines hypertension in ESC/ESH criteria?
JapaneseQuestion: 従来のESC/ESH基準で高血圧を定義する診察室血圧は？
EnglishAnswer: Repeated office blood pressure of at least 140/90 mmHg.
JapaneseAnswer: 反復測定した診察室血圧140/90 mmHg以上。

EnglishQuestion: How does the baroreceptor response raise blood pressure after a fall?
JapaneseQuestion: 血圧低下後、baroreceptor反応はどう血圧を上げるか？
EnglishAnswer: It increases sympathetic activity and vasoconstriction.
JapaneseAnswer: 交感神経活動と血管収縮を増加させる。

EnglishQuestion: How does reduced renal perfusion activate the renin-angiotensin-aldosterone system to raise blood pressure?
JapaneseQuestion: 腎灌流低下はRAASを介してどう血圧を上げるか？
EnglishAnswer: Renin generates angiotensin I, ACE forms angiotensin II, and angiotensin II causes vasoconstriction and aldosterone-mediated volume expansion.
JapaneseAnswer: reninがAng Iを生成し、ACEがAng IIへ変換し、Ang IIが血管収縮とaldosteroneによる体液量増加を起こす。

EnglishQuestion: What are the central pathophysiologic features of primary hypertension?
JapaneseQuestion: 本態性高血圧の中心病態は？
EnglishAnswer: Abnormal renal sodium handling and increased vascular resistance, influenced by genetic and environmental factors.
JapaneseAnswer: 遺伝・環境因子の影響を受ける腎Na処理異常と血管抵抗増加。

EnglishQuestion: Which lifestyle factors contribute to primary hypertension?
JapaneseQuestion: 本態性高血圧に寄与する生活習慣因子は？
EnglishAnswer: Obesity, smoking, physical inactivity, high sodium intake, stress, and diabetes.
JapaneseAnswer: 肥満、喫煙、運動不足、高塩分摂取、stress、糖尿病。

EnglishQuestion: Which renal diseases can cause secondary hypertension?
JapaneseQuestion: 二次性高血圧を起こす腎疾患は？
EnglishAnswer: Diabetic nephropathy, glomerulonephritis, vasculitis, pyelonephritis, and polycystic kidney disease.
JapaneseAnswer: 糖尿病性腎症、糸球体腎炎、血管炎、腎盂腎炎、多発性嚢胞腎。

EnglishQuestion: Which endocrine disorders can cause secondary hypertension?
JapaneseQuestion: 二次性高血圧を起こす内分泌疾患は？
EnglishAnswer: Primary aldosteronism, Cushing syndrome, pheochromocytoma, and hyperthyroidism or hypothyroidism.
JapaneseAnswer: 原発性aldosterone症、Cushing症候群、褐色細胞腫、甲状腺機能亢進症・低下症。

EnglishQuestion: Which nonrenal and nonendocrine causes should be considered in secondary hypertension?
JapaneseQuestion: 腎・内分泌以外の二次性高血圧原因は？
EnglishAnswer: Aortic coarctation, obstructive sleep apnea, pregnancy-related hypertension, NSAIDs, sympathomimetics, and oral contraceptives.
JapaneseAnswer: 大動脈縮窄、閉塞性睡眠時無呼吸、妊娠関連高血圧、NSAID、交感神経刺激薬、経口避妊薬。

EnglishQuestion: What defines a hypertensive emergency?
JapaneseQuestion: 高血圧緊急症を定義するものは？
EnglishAnswer: Severe hypertension with acute hypertension-mediated organ damage, not a blood pressure value alone.
JapaneseAnswer: 血圧値だけでなく、急性高血圧性臓器障害を伴うこと。

EnglishQuestion: Which acute organ injuries can define a hypertensive emergency?
JapaneseQuestion: 高血圧緊急症を定義し得る急性臓器障害は？
EnglishAnswer: Encephalopathy, stroke, acute coronary syndrome, acute heart failure, acute aortic syndrome, acute kidney injury, or advanced retinopathy.
JapaneseAnswer: 脳症、stroke、急性冠症候群、急性心不全、急性大動脈症候群、急性腎障害、高度網膜症。

EnglishQuestion: Which organs are damaged by long-standing hypertension?
JapaneseQuestion: 長期高血圧が障害する標的臓器は？
EnglishAnswer: The heart and vessels, brain, kidneys, eyes, and peripheral arteries.
JapaneseAnswer: 心血管、脳、腎、眼、末梢動脈。

EnglishQuestion: What early cardiac examination finding can reflect hypertensive left ventricular hypertrophy?
JapaneseQuestion: 高血圧性左室肥大を反映する早期身体所見は？
EnglishAnswer: An S4 heart sound.
JapaneseAnswer: S4心音。

EnglishQuestion: What are the traditional hypertension thresholds for office, home, and 24-hour ambulatory blood pressure?
JapaneseQuestion: 従来の診察室・家庭・24時間ABPMの高血圧閾値は？
EnglishAnswer: Office at least 140/90 mmHg, home at least 135/85 mmHg, and 24-hour mean at least 130/80 mmHg.
JapaneseAnswer: 診察室140/90 mmHg以上、家庭135/85 mmHg以上、24時間平均130/80 mmHg以上。

EnglishQuestion: Why are home and ambulatory blood pressure measurements useful?
JapaneseQuestion: 家庭血圧・ABPMが有用なのはなぜか？
EnglishAnswer: They confirm persistent hypertension and distinguish white-coat from masked hypertension when office and out-of-office measurements differ.
JapaneseAnswer: 高血圧の持続性を確認し、診察室内外の差から白衣高血圧と仮面高血圧を区別できるため。

EnglishQuestion: What is the overall strategy for treating hypertension?
JapaneseQuestion: 高血圧治療の全体的な戦略は？
EnglishAnswer: Combine lifestyle modification with risk- and comorbidity-guided drug therapy to prevent pressure-overload organ damage.
JapaneseAnswer: 生活習慣修正と、リスク・併存疾患に応じた薬物療法を組み合わせ、圧負荷による臓器障害を防ぐ。

EnglishQuestion: What office blood pressure ranges defined high-normal and grade 1 hypertension in the historical 2018 ESC/ESH algorithm?
JapaneseQuestion: 歴史的な2018年ESC/ESHアルゴリズムで、高値正常血圧と1度高血圧の診察室血圧範囲は？
EnglishAnswer: High-normal: 130-139/85-89 mmHg; grade 1: 140-159/90-99 mmHg.
JapaneseAnswer: 高値正常：130〜139/85〜89 mmHg、1度：140〜159/90〜99 mmHg。

EnglishQuestion: What office blood pressure ranges defined grade 2 and grade 3 hypertension in the historical 2018 ESC/ESH algorithm?
JapaneseQuestion: 歴史的な2018年ESC/ESHアルゴリズムで、2度と3度高血圧の診察室血圧範囲は？
EnglishAnswer: Grade 2: 160-179/100-109 mmHg; grade 3: >=180/>=110 mmHg.
JapaneseAnswer: 2度：160〜179/100〜109 mmHg、3度：180/110 mmHg以上。

EnglishQuestion: In the historical 2018 ESC/ESH algorithm, when was immediate drug treatment recommended for grade 1 hypertension?
JapaneseQuestion: 歴史的な2018年ESC/ESHアルゴリズムで、1度高血圧に直ちに薬物治療を推奨したのはいつか？
EnglishAnswer: When cardiovascular disease, renal disease, hypertension-mediated organ damage, or otherwise high or very-high cardiovascular risk was present.
JapaneseAnswer: 心血管疾患、腎疾患、高血圧性臓器障害、その他の高・超高心血管リスクがある場合。

EnglishQuestion: How were grade 2 and grade 3 hypertension managed in the historical 2018 ESC/ESH algorithm?
JapaneseQuestion: 歴史的な2018年ESC/ESHアルゴリズムで、2度・3度高血圧をどう管理したか？
EnglishAnswer: Start lifestyle measures and drug therapy immediately; in grade 3, rapidly assess for acute organ damage.
JapaneseAnswer: 生活習慣修正と薬物療法を直ちに開始し、3度では急性臓器障害を速やかに評価する。

EnglishQuestion: What distinguishes hypertensive emergency from severe hypertension without emergency?
JapaneseQuestion: 高血圧緊急症と、緊急症ではない重症高血圧を区別するものは？
EnglishAnswer: Acute hypertension-mediated organ damage, not the blood pressure grade alone.
JapaneseAnswer: 血圧の重症度だけではなく、急性高血圧性臓器障害の存在。

EnglishQuestion: How is hypertensive emergency treated?
JapaneseQuestion: 高血圧緊急症をどう治療するか？
EnglishAnswer: Use monitored intravenous therapy with controlled blood pressure reduction.
JapaneseAnswer: 監視下で静注薬を用い、血圧を管理された速度で低下させる。

EnglishQuestion: What daily sodium limit is listed as a hypertension lifestyle measure?
JapaneseQuestion: 高血圧の生活習慣改善として示される1日Na上限は？
EnglishAnswer: Less than 2.4 g/day.
JapaneseAnswer: 1日2.4 g未満。

EnglishQuestion: What alcohol, exercise, and BMI targets are listed for hypertension management?
JapaneseQuestion: 高血圧管理で示される飲酒、運動、BMIの目標は？
EnglishAnswer: No more than 2 drinks/day for men or 1 drink/day for women; at least 30 minutes of aerobic exercise 3 times weekly; BMI 20-25 kg/m2.
JapaneseAnswer: 飲酒は男性1日2杯、女性1日1杯まで、有酸素運動は少なくとも30分を週3回、BMI 20〜25 kg/m2。

EnglishQuestion: What dietary pattern is recommended for hypertension?
JapaneseQuestion: 高血圧で推奨される食事パターンは？
EnglishAnswer: Increase fruit, vegetables, whole grains, fish, legumes, and nuts; reduce saturated and trans fat, sweets, added sugar, and red meat.
JapaneseAnswer: 果物、野菜、全粒穀物、魚、豆、ナッツを増やし、飽和脂肪・トランス脂肪、菓子、添加糖、赤肉を減らす。

EnglishQuestion: Which comorbidities particularly favor an ACE inhibitor or ARB in hypertension?
JapaneseQuestion: 高血圧でACE阻害薬またはARBが特に適する併存疾患は？
EnglishAnswer: Heart failure, left ventricular hypertrophy, atrial fibrillation, and previous myocardial infarction.
JapaneseAnswer: 心不全、左室肥大、心房細動、心筋梗塞後。

EnglishQuestion: Should an ACE inhibitor and an ARB be combined for routine hypertension treatment?
JapaneseQuestion: 高血圧治療でACE阻害薬とARBをルーチンに併用するか？
EnglishAnswer: No.
JapaneseAnswer: 併用しない。

EnglishQuestion: Which clinical settings particularly favor a beta-blocker in hypertension?
JapaneseQuestion: 高血圧でβ遮断薬が特に適する臨床状況は？
EnglishAnswer: Angina, previous myocardial infarction, tachyarrhythmia, glaucoma, and pregnancy.
JapaneseAnswer: 狭心症、心筋梗塞後、頻脈性不整脈、緑内障、妊娠。

EnglishQuestion: What is a representative three-drug antihypertensive combination?
JapaneseQuestion: 代表的な3剤降圧薬の組み合わせは？
EnglishAnswer: An ACE inhibitor plus a calcium channel blocker plus a thiazide diuretic.
JapaneseAnswer: ACE阻害薬、Ca拮抗薬、サイアザイド系利尿薬の併用。

EnglishQuestion: Which diuretic may be considered in end-stage renal failure rather than a thiazide?
JapaneseQuestion: 末期腎不全でサイアザイド系より検討する利尿薬は？
EnglishAnswer: Furosemide.
JapaneseAnswer: フロセミド。

EnglishQuestion: What is the pathophysiologic sequence of hypertensive heart disease?
JapaneseQuestion: 高血圧性心疾患の病態の流れは？
EnglishAnswer: Systemic hypertension -> left ventricular pressure overload -> concentric left ventricular hypertrophy -> failure of myocyte adaptation -> diastolic or systolic dysfunction -> chronic heart failure, arrhythmia, or sudden cardiac death.
JapaneseAnswer: 全身性高血圧→左室圧負荷→求心性左室肥大→心筋細胞適応の破綻→拡張・収縮機能障害→慢性心不全、不整脈、突然心臓死。

EnglishQuestion: What cardiac changes can pulmonary hypertension cause?
JapaneseQuestion: 肺高血圧はどのような心臓変化を起こすか？
EnglishAnswer: Right ventricular hypertrophy or dilation, cor pulmonale, and right-sided heart failure.
JapaneseAnswer: 右室肥大・拡張、肺性心、右心不全。

EnglishQuestion: What symptoms can hypertensive heart disease cause?
JapaneseQuestion: 高血圧性心疾患で生じ得る症状は？
EnglishAnswer: Fatigue, irregular pulse, dyspnea, leg edema, weight gain, nausea, and bloating.
JapaneseAnswer: 倦怠感、不整脈、呼吸困難、下腿浮腫、体重増加、悪心、腹部膨満。

EnglishQuestion: What is the principal action of anticoagulant drugs?
JapaneseQuestion: 抗凝固薬の主な作用は？
EnglishAnswer: They inhibit the coagulation cascade and prevent fibrin clot formation.
JapaneseAnswer: 凝固カスケードを抑制し、フィブリン血栓形成を防ぐ。

EnglishQuestion: What fundamental risk-benefit assessment is required before anticoagulation?
JapaneseQuestion: 抗凝固療法前に必須のリスク・ベネフィット評価は？
EnglishAnswer: Compare the benefit of preventing thrombosis with the increased bleeding risk.
JapaneseAnswer: 血栓予防の利益と増加する出血リスクを比較する。

EnglishQuestion: What is the purpose of anticoagulation in atrial fibrillation?
JapaneseQuestion: 心房細動における抗凝固療法の目的は？
EnglishAnswer: Prevention of stroke and systemic embolism.
JapaneseAnswer: 脳卒中と全身性塞栓症の予防。

EnglishQuestion: Is stable coronary artery disease alone an indication for chronic anticoagulation?
JapaneseQuestion: 安定冠動脈疾患だけで慢性抗凝固療法の適応となるか？
EnglishAnswer: No.
JapaneseAnswer: 適応とならない。

EnglishQuestion: Which parenteral anticoagulants may be used during ACS or PCI?
JapaneseQuestion: ACS急性期またはPCI中に用い得る非経口抗凝固薬は？
EnglishAnswer: Unfractionated heparin, low-molecular-weight heparin, or bivalirudin, selected according to indication and bleeding risk.
JapaneseAnswer: 未分画ヘパリン、低分子ヘパリン、ビバリルジンを適応と出血リスクに応じて選択する。

EnglishQuestion: What is the standard long-term anticoagulant for a mechanical heart valve?
JapaneseQuestion: 機械弁の標準的な長期抗凝固薬は？
EnglishAnswer: A vitamin K antagonist, usually warfarin, used lifelong with an INR target based on valve position, valve type, and thromboembolic risk.
JapaneseAnswer: ビタミンK拮抗薬、通常ワルファリンを生涯使用し、弁位置・種類・血栓塞栓リスクに応じてINR目標を設定する。

EnglishQuestion: Can direct oral anticoagulants be used for mechanical heart valves?
JapaneseQuestion: 機械弁に直接経口抗凝固薬を使用できるか？
EnglishAnswer: No.
JapaneseAnswer: 使用できない。

EnglishQuestion: Should aspirin be routinely added to warfarin in every patient with a mechanical valve?
JapaneseQuestion: 機械弁患者全員でワルファリンにアスピリンをルーチン併用するか？
EnglishAnswer: No. Consider it only for another antiplatelet indication or selected thromboembolism despite an appropriate INR.
JapaneseAnswer: しない。別の抗血小板薬適応がある場合や、適切なINR下でも血栓塞栓を生じた選択例で検討する。

EnglishQuestion: When is perioperative heparin bridging considered for a mechanical valve?
JapaneseQuestion: 機械弁で周術期ヘパリンブリッジをいつ検討するか？
EnglishAnswer: For a mechanical mitral valve, an older-generation mechanical valve, or additional thromboembolic risk, after balancing bleeding risk; it is not routine for a bileaflet mechanical aortic valve without risk factors.
JapaneseAnswer: 機械僧帽弁、旧世代機械弁、追加の血栓塞栓リスクがある場合に出血リスクと比較して検討し、危険因子のない二葉型機械大動脈弁では通常不要。

EnglishQuestion: What are major nonvalvular indications for anticoagulation?
JapaneseQuestion: 抗凝固療法の主な非弁膜症適応は？
EnglishAnswer: Treatment and prevention of DVT or pulmonary embolism, intracavitary thrombus, and selected noncoronary structural interventions.
JapaneseAnswer: DVT・肺塞栓症の治療と予防、心腔内血栓、選択された非冠動脈性構造的治療。

EnglishQuestion: How does unfractionated heparin inhibit coagulation?
JapaneseQuestion: 未分画ヘパリンはどのように凝固を阻害するか？
EnglishAnswer: It binds antithrombin III and accelerates inactivation of thrombin, factor Xa, and other activated factors.
JapaneseAnswer: アンチトロンビンIIIに結合し、トロンビン、Xa因子など活性化凝固因子の不活化を促進する。

EnglishQuestion: Why does unfractionated heparin act rapidly, and how is it monitored?
JapaneseQuestion: 未分画ヘパリンが速効性なのはなぜで、どうモニターするか？
EnglishAnswer: It acts on existing coagulation factors and is monitored with aPTT.
JapaneseAnswer: 既存の凝固因子に作用するため速効性があり、aPTTでモニターする。

EnglishQuestion: How does low-molecular-weight heparin differ pharmacokinetically from unfractionated heparin?
JapaneseQuestion: 低分子ヘパリンは未分画ヘパリンと薬物動態がどう異なるか？
EnglishAnswer: It has higher bioavailability and a longer duration, allowing once- or twice-daily dosing.
JapaneseAnswer: バイオアベイラビリティが高く作用時間が長いため、1日1〜2回投与できる。

EnglishQuestion: Which drugs directly inhibit thrombin?
JapaneseQuestion: トロンビンを直接阻害する薬剤は？
EnglishAnswer: Bivalirudin and dabigatran.
JapaneseAnswer: ビバリルジンとダビガトラン。

EnglishQuestion: Which drug directly inhibits factor Xa?
JapaneseQuestion: Xa因子を直接阻害する薬剤は？
EnglishAnswer: Rivaroxaban.
JapaneseAnswer: リバーロキサバン。

EnglishQuestion: How does warfarin inhibit coagulation?
JapaneseQuestion: ワルファリンはどのように凝固を阻害するか？
EnglishAnswer: It inhibits vitamin K epoxide reductase and reduces synthesis of vitamin K-dependent factors II, VII, IX, and X.
JapaneseAnswer: ビタミンKエポキシド還元酵素を阻害し、ビタミンK依存性II、VII、IX、X因子の合成を減らす。

EnglishQuestion: How do heparin and warfarin differ in onset of action?
JapaneseQuestion: ヘパリンとワルファリンは作用発現がどう異なるか？
EnglishAnswer: Heparin acts immediately on existing factors; warfarin has a delayed onset because it inhibits synthesis of new vitamin K-dependent factors.
JapaneseAnswer: ヘパリンは既存因子に作用して速効性だが、ワルファリンは新たなビタミンK依存性因子の合成を阻害するため遅効性。

EnglishQuestion: What important pregnancy restriction applies to warfarin?
JapaneseQuestion: ワルファリンに関する重要な妊娠上の制限は？
EnglishAnswer: It is contraindicated in pregnancy.
JapaneseAnswer: 妊娠中は禁忌。

EnglishQuestion: What are thrombolytic drugs and how do they act?
JapaneseQuestion: 血栓溶解薬とは何で、どう作用するか？
EnglishAnswer: Agents such as alteplase and reteplase convert plasminogen to plasmin, which degrades fibrin and fibrinogen in an existing clot.
JapaneseAnswer: アルテプラーゼ、レテプラーゼなどがプラスミノゲンをプラスミンへ変換し、既存血栓のフィブリン・フィブリノゲンを分解する。

EnglishQuestion: How do anticoagulants and thrombolytics differ in their targets?
JapaneseQuestion: 抗凝固薬と血栓溶解薬は標的がどう異なるか？
EnglishAnswer: Anticoagulants prevent fibrin clot formation; thrombolytics dissolve an already formed clot.
JapaneseAnswer: 抗凝固薬はフィブリン血栓形成を防ぎ、血栓溶解薬は形成済み血栓を溶解する。

EnglishQuestion: What critical diagnosis must be excluded before thrombolytic therapy?
JapaneseQuestion: 血栓溶解療法前に除外すべき重要な診断は？
EnglishAnswer: Cerebral hemorrhage.
JapaneseAnswer: 脳出血。

EnglishQuestion: How should the age components and female-sex component of CHA2DS2-VASc be interpreted?
JapaneseQuestion: CHA2DS2-VAScの年齢項目と女性項目をどう解釈するか？
EnglishAnswer: Do not add both age categories; female sex is a risk modifier and should not by itself trigger anticoagulation.
JapaneseAnswer: 年齢項目は重複加点せず、女性はリスク修飾因子であり、女性1点だけで抗凝固を開始しない。

EnglishQuestion: What is the principal action of antiplatelet drugs?
JapaneseQuestion: 抗血小板薬の主な作用は？
EnglishAnswer: They inhibit platelet activation and aggregation, thereby preventing platelet-rich arterial thrombosis.
JapaneseAnswer: 血小板活性化・凝集を抑制し、血小板に富む動脈血栓を予防する。

EnglishQuestion: How does aspirin inhibit platelet aggregation?
JapaneseQuestion: アスピリンはどのように血小板凝集を抑制するか？
EnglishAnswer: It inhibits COX-1 and reduces thromboxane A2 synthesis.
JapaneseAnswer: COX-1を阻害し、トロンボキサンA2合成を低下させる。

EnglishQuestion: Which drugs inhibit the platelet P2Y12 receptor?
JapaneseQuestion: 血小板P2Y12受容体を阻害する薬剤は？
EnglishAnswer: Clopidogrel, prasugrel, and ticagrelor.
JapaneseAnswer: クロピドグレル、プラスグレル、チカグレロル。

EnglishQuestion: How do P2Y12 inhibitors reduce platelet aggregation?
JapaneseQuestion: P2Y12阻害薬はどのように血小板凝集を減らすか？
EnglishAnswer: They block ADP-mediated platelet activation and aggregation.
JapaneseAnswer: ADPを介する血小板活性化・凝集を阻害する。

EnglishQuestion: How does abciximab inhibit platelet aggregation?
JapaneseQuestion: アブシキシマブはどのように血小板凝集を抑制するか？
EnglishAnswer: It blocks ligand binding to the GPIIb/IIIa receptor and prevents fibrinogen-mediated platelet cross-linking.
JapaneseAnswer: GPIIb/IIIa受容体へのリガンド結合を阻害し、フィブリノゲンを介する血小板架橋を防ぐ。

EnglishQuestion: Which P2Y12 inhibitors are prodrugs, and which is active without metabolic activation?
JapaneseQuestion: どのP2Y12阻害薬がプロドラッグで、どれが代謝活性化を必要としないか？
EnglishAnswer: Clopidogrel and prasugrel are prodrugs; ticagrelor is not.
JapaneseAnswer: クロピドグレルとプラスグレルはプロドラッグで、チカグレロルはプロドラッグではない。

EnglishQuestion: How do clopidogrel, prasugrel, and ticagrelor differ in receptor binding?
JapaneseQuestion: クロピドグレル、プラスグレル、チカグレロルは受容体結合がどう異なるか？
EnglishAnswer: Clopidogrel and prasugrel bind irreversibly; ticagrelor binds reversibly.
JapaneseAnswer: クロピドグレルとプラスグレルは不可逆的、チカグレロルは可逆的に結合する。

EnglishQuestion: What are representative loading doses of clopidogrel, prasugrel, and ticagrelor in ACS or PCI regimens?
JapaneseQuestion: ACS・PCIレジメンにおけるクロピドグレル、プラスグレル、チカグレロルの代表的負荷量は？
EnglishAnswer: Clopidogrel 600 mg, prasugrel 60 mg, and ticagrelor 180 mg.
JapaneseAnswer: クロピドグレル600 mg、プラスグレル60 mg、チカグレロル180 mg。

EnglishQuestion: What are representative maintenance doses of clopidogrel, prasugrel, and ticagrelor?
JapaneseQuestion: クロピドグレル、プラスグレル、チカグレロルの代表的維持量は？
EnglishAnswer: Clopidogrel 75 mg once daily, prasugrel 10 mg once daily, and ticagrelor 90 mg twice daily.
JapaneseAnswer: クロピドグレル75 mg 1日1回、プラスグレル10 mg 1日1回、チカグレロル90 mg 1日2回。

EnglishQuestion: Which factors require individualization of P2Y12 inhibitor dosing and selection?
JapaneseQuestion: P2Y12阻害薬の用量・選択を個別化する要因は？
EnglishAnswer: Bleeding risk, age, body weight, concomitant anticoagulation, and the treatment strategy.
JapaneseAnswer: 出血リスク、年齢、体重、併用抗凝固薬、治療戦略。

EnglishQuestion: What is the critical contraindication to prasugrel?
JapaneseQuestion: プラスグレルの重要な禁忌は？
EnglishAnswer: A history of stroke or transient ischemic attack.
JapaneseAnswer: 脳卒中または一過性脳虚血発作の既往。

EnglishQuestion: What are major secondary-prevention uses of aspirin?
JapaneseQuestion: アスピリンの主な二次予防用途は？
EnglishAnswer: Prevention after myocardial infarction and after noncardioembolic TIA or ischemic stroke.
JapaneseAnswer: 心筋梗塞後、および非心原性TIA・虚血性脳卒中後の再発予防。

EnglishQuestion: Is aspirin routinely used for primary prevention in people without cardiovascular disease?
JapaneseQuestion: 心血管疾患のない人にアスピリンを一次予防としてルーチンに用いるか？
EnglishAnswer: No. Consider it only selectively when atherosclerotic cardiovascular risk is high and bleeding risk is low.
JapaneseAnswer: 用いない。動脈硬化性心血管リスクが高く出血リスクが低い一部で個別に検討する。

EnglishQuestion: What are major clinical uses of clopidogrel?
JapaneseQuestion: クロピドグレルの主な臨床用途は？
EnglishAnswer: ACS or PCI, prevention of stent thrombosis, and secondary prevention after noncardioembolic TIA or ischemic stroke when used as an aspirin alternative.
JapaneseAnswer: ACS・PCI、ステント血栓症予防、アスピリン代替としての非心原性TIA・虚血性脳卒中二次予防。

EnglishQuestion: What is the main clinical setting for prasugrel?
JapaneseQuestion: プラスグレルの主な使用場面は？
EnglishAnswer: ACS treated with PCI, in combination with aspirin.
JapaneseAnswer: PCIを行うACSで、アスピリンと併用する。

EnglishQuestion: When is abciximab used during PCI?
JapaneseQuestion: PCI中にアブシキシマブをいつ用いるか？
EnglishAnswer: Selectively as bailout therapy for a large thrombus burden, no-reflow, or slow-flow; not routinely.
JapaneseAnswer: 大きな血栓量、no-reflow、slow-flowに対するベイルアウトとして選択的に用い、ルーチン使用しない。

EnglishQuestion: Is abciximab a drug for preventing restenosis?
JapaneseQuestion: アブシキシマブは再狭窄予防薬か？
EnglishAnswer: No.
JapaneseAnswer: 再狭窄予防薬ではない。

EnglishQuestion: How do antiplatelet drugs and anticoagulants differ in their main targets?
JapaneseQuestion: 抗血小板薬と抗凝固薬は主な標的がどう異なるか？
EnglishAnswer: Antiplatelet drugs target platelets in high-shear arterial thrombosis; anticoagulants target coagulation factors and fibrin formation.
JapaneseAnswer: 抗血小板薬は高ずり応力下の動脈血栓における血小板を、抗凝固薬は凝固因子とフィブリン形成を標的とする。

EnglishQuestion: What is ischemic heart disease (IHD)?
JapaneseQuestion: 虚血性心疾患（IHD）とは？
EnglishAnswer: A state in which myocardial oxygen supply is insufficient to meet myocardial demand.
JapaneseAnswer: 心筋酸素供給が心筋需要を満たせない状態。

EnglishQuestion: What is the most common cause of ischemic heart disease?
JapaneseQuestion: 虚血性心疾患の最も多い原因は？
EnglishAnswer: Coronary artery disease caused by coronary atherosclerosis.
JapaneseAnswer: 冠動脈粥状硬化による冠動脈疾患。

EnglishQuestion: Which conditions belong to the stable spectrum of ischemic heart disease?
JapaneseQuestion: 虚血性心疾患の安定型スペクトラムに含まれる病態は？
EnglishAnswer: Asymptomatic coronary artery disease, silent ischemia, and stable angina.
JapaneseAnswer: 無症候性冠動脈疾患、無症候性虚血、安定狭心症。

EnglishQuestion: Which conditions belong to the unstable spectrum of ischemic heart disease?
JapaneseQuestion: 虚血性心疾患の不安定型スペクトラムに含まれる病態は？
EnglishAnswer: Unstable angina, NSTEMI, STEMI, and sudden cardiac death.
JapaneseAnswer: 不安定狭心症、NSTEMI、STEMI、突然心臓死。

EnglishQuestion: What clinical manifestations can ischemic heart disease have besides chest pain?
JapaneseQuestion: 胸痛以外に虚血性心疾患はどのような臨床像を呈し得るか？
EnglishAnswer: Silent ischemia, ischemic heart failure or cardiomyopathy, conduction disturbances, arrhythmias, acute coronary syndrome, and sudden cardiac death.
JapaneseAnswer: 無症候性虚血、虚血性心不全・心筋症、伝導障害、不整脈、急性冠症候群、突然心臓死。

EnglishQuestion: How are unstable angina and NSTEMI distinguished within NSTE-ACS?
JapaneseQuestion: NSTE-ACS内で不安定狭心症とNSTEMIをどう区別するか？
EnglishAnswer: NSTEMI has a rise in troponin indicating myocardial injury; unstable angina does not.
JapaneseAnswer: NSTEMIでは心筋障害を示すトロポニン上昇があり、不安定狭心症ではない。

EnglishQuestion: How is STEMI identified within acute coronary syndrome?
JapaneseQuestion: 急性冠症候群の中でSTEMIをどう同定するか？
EnglishAnswer: As acute myocardial infarction presenting with persistent ST-segment elevation.
JapaneseAnswer: 持続性ST上昇を伴う急性心筋梗塞として同定する。

EnglishQuestion: Why does the percentage of coronary stenosis alone not predict acute coronary syndrome?
JapaneseQuestion: 冠動脈狭窄率だけで急性冠症候群を予測できないのはなぜか？
EnglishAnswer: Plaque instability and acute thrombosis can arise from a lesion that was not severely stenotic.
JapaneseAnswer: 高度狭窄でなかった病変からもプラーク不安定化と急性血栓が生じ得るため。

EnglishQuestion: What is the pathophysiologic difference between stable angina and acute coronary syndrome?
JapaneseQuestion: 安定狭心症と急性冠症候群の病態生理の違いは？
EnglishAnswer: Stable angina usually reflects fixed stenosis causing supply-demand mismatch; ACS reflects plaque instability or rupture with acute thrombosis.
JapaneseAnswer: 安定狭心症は通常固定狭窄による需給不均衡、ACSはプラーク不安定化・破裂と急性血栓を反映する。

EnglishQuestion: What symptoms commonly suggest myocardial ischemia?
JapaneseQuestion: 心筋虚血を示唆する一般的な症状は？
EnglishAnswer: Angina radiating to the jaw, shoulder, or arm, paresthesia, dyspnea, and anxiety, often with relief from sublingual nitrate.
JapaneseAnswer: 顎、肩、腕へ放散する狭心痛、異常感覚、呼吸困難、不安で、舌下硝酸薬で軽快することが多い。

EnglishQuestion: What ECG changes can suggest ischemic heart disease?
JapaneseQuestion: 虚血性心疾患を示唆する心電図変化は？
EnglishAnswer: ST depression, flat or inverted T waves, and evidence of old myocardial infarction.
JapaneseAnswer: ST低下、平坦または陰性T波、陳旧性心筋梗塞所見。

EnglishQuestion: What is the initial evaluation sequence for suspected ischemic heart disease?
JapaneseQuestion: 虚血性心疾患疑いの初期評価の流れは？
EnglishAnswer: History and physical examination with risk-factor assessment -> resting ECG -> selected Holter, chest radiography, echocardiography or stress testing -> coronary CT, MRI, or invasive angiography when indicated.
JapaneseAnswer: 病歴・身体診察と危険因子評価→安静時心電図→必要に応じHolter、胸部X線、心エコー・負荷試験→適応に応じ冠動脈CT、MRI、侵襲的冠動脈造影。

EnglishQuestion: Which systemic conditions should be assessed as risk factors or contributors to ischemia?
JapaneseQuestion: 虚血の危険因子・増悪因子として評価すべき全身病態は？
EnglishAnswer: Hyperlipidemia, diabetes, anemia, and thyrotoxicosis.
JapaneseAnswer: 脂質異常症、糖尿病、貧血、甲状腺中毒症。

EnglishQuestion: What is the current concept replacing the older term cardiac syndrome X?
JapaneseQuestion: 旧称「心臓症候群X」に代わる現在の概念は？
EnglishAnswer: ANOCA or INOCA, including microvascular angina and vasospastic mechanisms in patients with angina or objective ischemia but no obstructive epicardial coronary disease.
JapaneseAnswer: 閉塞性心外膜冠動脈疾患がない狭心症・客観的虚血を、微小血管狭心症や冠攣縮機序を含むANOCA・INOCAとして評価する。

EnglishQuestion: Which drugs may be used for ANOCA or INOCA according to mechanism and comorbidity?
JapaneseQuestion: ANOCA・INOCAで機序と併存疾患に応じて用い得る薬剤は？
EnglishAnswer: Beta-blockers, calcium channel blockers, ACE inhibitors, and statins.
JapaneseAnswer: β遮断薬、Ca拮抗薬、ACE阻害薬、スタチン。

EnglishQuestion: Who is particularly prone to silent myocardial ischemia or infarction?
JapaneseQuestion: 無症候性心筋虚血・梗塞を起こしやすいのは誰か？
EnglishAnswer: Older adults and patients with diabetes or autonomic neuropathy.
JapaneseAnswer: 高齢者、糖尿病患者、自律神経障害患者。

EnglishQuestion: What are the three Cohn classes of silent ischemia?
JapaneseQuestion: 無症候性虚血のCohn分類3型は？
EnglishAnswer: Class 1: severe obstructive CAD but completely asymptomatic; class 2: silent ischemia after documented MI; class 3: silent episodes in patients with chronic stable, unstable, or Prinzmetal angina.
JapaneseAnswer: 1型：重症閉塞性CADだが完全無症候、2型：確認されたMI後の無症候性虚血、3型：安定・不安定・異型狭心症患者に無症候性エピソードを併発。

EnglishQuestion: What is total ischemic burden?
JapaneseQuestion: 総虚血負荷とは？
EnglishAnswer: The sum of silent ischemic episodes and symptomatic angina episodes.
JapaneseAnswer: 無症候性虚血エピソードと症候性狭心症エピソードの総和。

EnglishQuestion: Which atypical manifestations should raise concern for silent ischemia or infarction?
JapaneseQuestion: 無症候性虚血・梗塞を疑うべき非典型的症状は？
EnglishAnswer: Presyncope or syncope, pulmonary edema, epigastric pain, nausea or vomiting, postoperative hypotension, oliguria, and stroke or TIA.
JapaneseAnswer: 前失神・失神、肺水腫、心窩部痛、悪心・嘔吐、術後低血圧、乏尿、脳卒中・TIA。

EnglishQuestion: How is silent ischemia treated compared with symptomatic ischemic heart disease?
JapaneseQuestion: 無症候性虚血は症候性虚血性心疾患と比べてどう治療するか？
EnglishAnswer: It is treated according to the same principles as symptomatic ischemic heart disease.
JapaneseAnswer: 症候性虚血性心疾患と同じ原則で治療する。

EnglishQuestion: What is angina pectoris?
JapaneseQuestion: 狭心症とは？
EnglishAnswer: A symptom of reversible myocardial ischemia.
JapaneseAnswer: 可逆的心筋虚血の症状。

EnglishQuestion: What is the classic clinical pattern of angina?
JapaneseQuestion: 狭心症の典型的な臨床パターンは？
EnglishAnswer: Retrosternal pressure radiating to the jaw, shoulder, or arm, provoked by exertion or stress and relieved by rest or nitroglycerin.
JapaneseAnswer: 顎、肩、腕へ放散する胸骨後部圧迫痛で、労作・ストレスで誘発され、安静またはニトログリセリンで軽快する。

EnglishQuestion: Which cardiac factors can increase myocardial oxygen demand and provoke angina?
JapaneseQuestion: 心筋酸素需要を増やし狭心症を誘発する心臓性因子は？
EnglishAnswer: Tachyarrhythmia, bradyarrhythmia, and aortic valve disease.
JapaneseAnswer: 頻脈性不整脈、徐脈性不整脈、大動脈弁疾患。

EnglishQuestion: Which extracardiac factors can provoke myocardial supply-demand mismatch?
JapaneseQuestion: 心筋酸素需給不均衡を起こし得る心外性因子は？
EnglishAnswer: Anemia, hypertension, fever, and hyperthyroidism.
JapaneseAnswer: 貧血、高血圧、発熱、甲状腺機能亢進症。

EnglishQuestion: What are the major risk factors for angina due to coronary artery disease?
JapaneseQuestion: 冠動脈疾患による狭心症の主な危険因子は？
EnglishAnswer: Smoking, diabetes, hypercholesterolemia, hypertension, obesity, family history, and age.
JapaneseAnswer: 喫煙、糖尿病、高コレステロール血症、高血圧、肥満、家族歴、年齢。

EnglishQuestion: What is the mechanism and symptom pattern of stable effort angina?
JapaneseQuestion: 安定労作性狭心症の機序と症状パターンは？
EnglishAnswer: Fixed coronary stenosis from stable atheroma causes demand-induced constricting pain during exertion, emotional stress, or cold that lasts minutes and improves with rest or nitroglycerin.
JapaneseAnswer: 安定プラークによる固定性冠狭窄があり、労作・精神的ストレス・寒冷で数分間の絞扼痛を生じ、安静またはニトログリセリンで軽快する。

EnglishQuestion: What is the mechanism of unstable angina?
JapaneseQuestion: 不安定狭心症の機序は？
EnglishAnswer: Acute thrombus formation over a ruptured or otherwise unstable plaque.
JapaneseAnswer: 破裂または不安定化したプラーク上の急性血栓形成。

EnglishQuestion: What is the mechanism and ECG pattern of Prinzmetal angina?
JapaneseQuestion: Prinzmetal狭心症の機序と心電図パターンは？
EnglishAnswer: Transient coronary spasm causing transient ST-segment elevation, usually relieved by nitroglycerin.
JapaneseAnswer: 一過性冠攣縮により一過性ST上昇を生じ、通常ニトログリセリンで解除される。

EnglishQuestion: How do stable, unstable, and Prinzmetal angina differ?
JapaneseQuestion: 安定、不安定、Prinzmetal狭心症はどう異なるか？
EnglishAnswer: Stable angina is demand ischemia from fixed stenosis; unstable angina is ACS from plaque disruption and acute thrombus; Prinzmetal angina is transient coronary spasm with transient ST elevation.
JapaneseAnswer: 安定狭心症は固定狭窄による需要性虚血、不安定狭心症はプラーク破綻と急性血栓によるACS、Prinzmetal狭心症は一過性ST上昇を伴う冠攣縮。

EnglishQuestion: What complications are particularly associated with unstable angina involving papillary muscle ischemia?
JapaneseQuestion: 乳頭筋虚血を伴う不安定狭心症で特に起こり得る合併症は？
EnglishAnswer: Contractile or conduction dysfunction and mitral regurgitation when the papillary muscle is involved.
JapaneseAnswer: 収縮・伝導障害と、乳頭筋が障害された場合の僧帽弁逆流。

EnglishQuestion: What arrhythmic risk is associated with Prinzmetal angina?
JapaneseQuestion: Prinzmetal狭心症に関連する不整脈リスクは？
EnglishAnswer: Ventricular tachycardia.
JapaneseAnswer: 心室頻拍。

EnglishQuestion: Which tests assess inducible ischemia and coronary anatomy in stable angina?
JapaneseQuestion: 安定狭心症で誘発性虚血と冠動脈解剖を評価する検査は？
EnglishAnswer: Exercise stress testing when feasible, stress echocardiography, perfusion imaging, and coronary CT angiography; invasive angiography is used for selected high-risk or refractory cases.
JapaneseAnswer: 可能なら運動負荷試験、負荷心エコー、灌流画像、冠動脈CT造影を用い、高リスク・薬物抵抗性の選択例では侵襲的冠動脈造影を行う。

EnglishQuestion: What is the role of low-dose dobutamine during stress echocardiography?
JapaneseQuestion: ドブタミン負荷心エコーの低用量相の主な役割は？
EnglishAnswer: Assessment of myocardial viability.
JapaneseAnswer: 心筋バイアビリティの評価。

EnglishQuestion: When is invasive coronary angiography considered in stable angina?
JapaneseQuestion: 安定狭心症で侵襲的冠動脈造影をいつ検討するか？
EnglishAnswer: For high-risk findings, symptoms refractory to medical therapy, or when revascularization is being considered, rather than automatically by symptom class alone.
JapaneseAnswer: 高リスク所見、薬物治療抵抗性症状、血行再建を検討する場合で、症状クラスだけで自動的に決めない。

EnglishQuestion: What does the traditional ABCDE mnemonic summarize in stable angina management?
JapaneseQuestion: 安定狭心症管理の伝統的ABCDEは何をまとめるか？
EnglishAnswer: Aspirin or clopidogrel when indicated and antianginal therapy; beta-blocker or calcium channel blocker; cigarette cessation and high-intensity statin; diet and diabetes management; education and exercise.
JapaneseAnswer: 適応に応じたアスピリンまたはクロピドグレルと抗狭心症治療、β遮断薬・Ca拮抗薬、禁煙と高強度スタチン、食事・糖尿病管理、教育・運動。

EnglishQuestion: How is vasospastic angina evaluated?
JapaneseQuestion: 冠攣縮性狭心症をどう評価するか？
EnglishAnswer: Document transient ST changes during symptoms by ECG or Holter, exclude obstructive coronary disease according to risk, and consider provocative testing at an expert center when needed.
JapaneseAnswer: 発作時心電図またはHolterで一過性ST変化を記録し、リスクに応じ閉塞性冠動脈疾患を除外し、必要時専門施設で誘発試験を検討する。

EnglishQuestion: How are STEMI, NSTEMI, and unstable angina separated in the ACS diagnostic flow?
JapaneseQuestion: ACS診断の流れでSTEMI、NSTEMI、不安定狭心症をどう分けるか？
EnglishAnswer: Persistent ST elevation -> STEMI pathway; no persistent ST elevation -> NSTE-ACS -> troponin rise or fall present: NSTEMI; absent: unstable angina after reassessing alternatives.
JapaneseAnswer: 持続性ST上昇→STEMI経路、持続性ST上昇なし→NSTE-ACS→トロポニン上昇・下降あり：NSTEMI、なし：他原因を再評価したうえで不安定狭心症。

EnglishQuestion: Why do angiographic occlusion severity and ECG ACS classification not correspond one-to-one?
JapaneseQuestion: 冠動脈閉塞度と心電図によるACS分類が一対一に対応しないのはなぜか？
EnglishAnswer: Complete occlusion may occur without ST elevation, and partial occlusion may produce transient ST elevation; symptoms, serial troponin, ECG, and anatomy must be integrated.
JapaneseAnswer: 完全閉塞でもST上昇を示さず、部分閉塞でも一過性ST上昇を示し得るため、症状、経時トロポニン、心電図、解剖を統合する。

EnglishQuestion: What mechanisms other than plaque disruption can cause acute coronary syndrome?
JapaneseQuestion: プラーク破綻以外に急性冠症候群を起こし得る機序は？
EnglishAnswer: Coronary spasm, coronary embolism, and spontaneous coronary artery dissection.
JapaneseAnswer: 冠攣縮、冠動脈塞栓、特発性冠動脈解離。

EnglishQuestion: What is the urgent initial evaluation for suspected ACS?
JapaneseQuestion: ACS疑いの緊急初期評価は？
EnglishAnswer: Assess pain characteristics, onset, radiation, risk factors, dyspnea and autonomic signs; record a 12-lead ECG promptly and obtain serial high-sensitivity troponin, with imaging for pulmonary embolism, aortic dissection, or pulmonary disease when needed.
JapaneseAnswer: 疼痛の性状・発症・放散、危険因子、呼吸困難・自律神経症状を評価し、速やかに12誘導心電図と経時的高感度トロポニンを行い、必要時PE、大動脈解離、肺疾患の画像評価を行う。

EnglishQuestion: What is the core pathophysiology of non-ST-segment elevation acute coronary syndrome (NSTE-ACS)?
JapaneseQuestion: 非ST上昇型急性冠症候群（NSTE-ACS）の基本病態は？
EnglishAnswer: Partial coronary artery occlusion causing subendocardial ischemia.
JapaneseAnswer: 冠動脈の部分閉塞による心内膜下虚血。

EnglishQuestion: What distinguishes unstable angina from NSTEMI within NSTE-ACS?
JapaneseQuestion: NSTE-ACSにおいて不安定狭心症とNSTEMIを区別するものは？
EnglishAnswer: NSTEMI has myocardial necrosis with elevated cardiac biomarkers; unstable angina has no myocardial necrosis or significant biomarker elevation.
JapaneseAnswer: NSTEMIでは心筋壊死と心筋バイオマーカー上昇があり、不安定狭心症では心筋壊死や有意なバイオマーカー上昇がない。

EnglishQuestion: What ECG changes commonly occur in NSTEMI?
JapaneseQuestion: NSTEMIで一般的にみられる心電図変化は？
EnglishAnswer: ST-segment depression and T-wave inversion.
JapaneseAnswer: ST低下とT波陰転化。

EnglishQuestion: How does the clinical pattern of unstable angina typically change?
JapaneseQuestion: 不安定狭心症の臨床パターンは通常どのように変化するか？
EnglishAnswer: Angina may occur at rest and increases in frequency or severity.
JapaneseAnswer: 狭心症が安静時にも起こり、頻度または重症度が増す。

EnglishQuestion: What is the diagnostic flow from partial coronary occlusion to unstable angina or NSTEMI?
JapaneseQuestion: 冠動脈部分閉塞から不安定狭心症またはNSTEMIに至る診断の流れは？
EnglishAnswer: Partial coronary occlusion -> subendocardial ischemia -> no myocardial necrosis: unstable angina; myocardial necrosis present: NSTEMI.
JapaneseAnswer: 冠動脈部分閉塞→心内膜下虚血→心筋壊死なし：不安定狭心症、心筋壊死あり：NSTEMI。

EnglishQuestion: How do patients with NSTE-ACS generally differ from patients with STEMI?
JapaneseQuestion: NSTE-ACS患者は一般にSTEMI患者とどう異なるか？
EnglishAnswer: They are usually older, have more comorbidities, and have a similar or worse prognosis.
JapaneseAnswer: 一般に高齢で併存疾患が多く、予後は同等または不良である。

EnglishQuestion: Which arrhythmic complications can result from necrotic myocardium in NSTEMI?
JapaneseQuestion: NSTEMIの壊死心筋により、どのような不整脈合併症が起こり得るか？
EnglishAnswer: Conduction disturbances and arrhythmias.
JapaneseAnswer: 伝導障害と不整脈。

EnglishQuestion: Which coronary lesion typically causes right ventricular infarction?
JapaneseQuestion: 右室梗塞を典型的に起こす冠動脈病変は？
EnglishAnswer: Proximal right coronary artery (RCA) occlusion.
JapaneseAnswer: 右冠動脈（RCA）近位部閉塞。

EnglishQuestion: Which biomarker is central to the current diagnosis of myocardial injury in NSTE-ACS?
JapaneseQuestion: 現在のNSTE-ACSにおける心筋障害診断の中心となるバイオマーカーは？
EnglishAnswer: High-sensitivity cardiac troponin (hs-cTn).
JapaneseAnswer: 高感度心筋トロポニン（hs-cTn）。

EnglishQuestion: How should high-sensitivity cardiac troponin be interpreted in suspected NSTE-ACS?
JapaneseQuestion: NSTE-ACS疑いで高感度心筋トロポニンをどう解釈するか？
EnglishAnswer: Integrate the absolute value and serial change in a 0/1-hour or 0/2-hour algorithm with symptom onset, the assay-specific cutoff, the clinical picture, and the ECG.
JapaneseAnswer: 0/1時間または0/2時間アルゴリズムの絶対値と経時変化を、症状発現時刻、測定法固有のカットオフ、臨床像、心電図と統合する。

EnglishQuestion: Does an elevated high-sensitivity cardiac troponin level by itself prove that acute coronary syndrome is the cause?
JapaneseQuestion: 高感度心筋トロポニン上昇だけで、原因が急性冠症候群だと証明できるか？
EnglishAnswer: No. It proves myocardial injury; the cause must be determined from the clinical picture and ECG.
JapaneseAnswer: できない。心筋障害を示すが、原因は臨床像と心電図から判断する。

EnglishQuestion: What is the typical time course of CK-MB after myocardial infarction?
JapaneseQuestion: 心筋梗塞後のCK-MBの典型的な時間経過は？
EnglishAnswer: It rises at about 3-6 hours, peaks at 12-24 hours, and remains elevated for about 2-3 days.
JapaneseAnswer: 約3〜6時間で上昇し、12〜24時間でピークとなり、約2〜3日持続する。

EnglishQuestion: How long can high-sensitivity cardiac troponin remain elevated after myocardial injury?
JapaneseQuestion: 心筋障害後、高感度心筋トロポニンはどの程度持続して上昇し得るか？
EnglishAnswer: For several days.
JapaneseAnswer: 数日間。

EnglishQuestion: Why are LDH and myoglobin not routinely used for current ACS diagnosis?
JapaneseQuestion: 現在のACS診断でLDHとミオグロビンをルーチンに用いないのはなぜか？
EnglishAnswer: LDH rises late and is a historical marker; myoglobin rises early but has low specificity.
JapaneseAnswer: LDHは上昇が遅い歴史的マーカーであり、ミオグロビンは早期に上昇するが特異度が低いため。

EnglishQuestion: Why should a single troponin measurement at a fixed time not be used alone to assess suspected NSTE-ACS?
JapaneseQuestion: NSTE-ACS疑いの評価で、固定時刻のトロポニン単回測定だけを用いてはいけないのはなぜか？
EnglishAnswer: Diagnostic accuracy depends on the time from symptom onset, the assay-specific cutoff, and the serial change.
JapaneseAnswer: 診断精度は症状発現からの時間、測定法固有のカットオフ、経時変化に依存するため。

EnglishQuestion: What three processes should proceed in parallel during management of NSTE-ACS?
JapaneseQuestion: NSTE-ACS管理で並行して進めるべき3つの過程は？
EnglishAnswer: Initial medical treatment, risk stratification, and selection of the timing of an invasive strategy.
JapaneseAnswer: 初期薬物治療、リスク層別化、侵襲的戦略の時期選択。

EnglishQuestion: Which findings are integrated to diagnose NSTE-ACS?
JapaneseQuestion: NSTE-ACSの診断では、どの所見を統合するか？
EnglishAnswer: Chest pain, ECG findings, cardiac troponin, and echocardiography, together with the overall clinical picture.
JapaneseAnswer: 胸痛、心電図、心筋トロポニン、心エコーを全体的な臨床像と統合する。

EnglishQuestion: Why should the classic MONA/BASC mnemonic not be applied indiscriminately in NSTE-ACS?
JapaneseQuestion: NSTE-ACSで古典的なMONA/BASCを一律に適用してはいけないのはなぜか？
EnglishAnswer: Each drug has a specific indication, contraindication, and risk profile; not every patient should receive every component.
JapaneseAnswer: 各薬剤には固有の適応、禁忌、リスクがあり、全患者に全成分を投与すべきではないため。

EnglishQuestion: What is the foundational antiplatelet drug in initial NSTE-ACS treatment?
JapaneseQuestion: NSTE-ACS初期治療の基本となる抗血小板薬は？
EnglishAnswer: Aspirin.
JapaneseAnswer: アスピリン。

EnglishQuestion: When are oxygen, nitroglycerin, and morphine used in NSTE-ACS?
JapaneseQuestion: NSTE-ACSで酸素、ニトログリセリン、モルヒネはいつ用いるか？
EnglishAnswer: Oxygen for hypoxemia; nitroglycerin for ischemic symptoms after checking blood pressure and contraindications; morphine only for refractory pain.
JapaneseAnswer: 酸素は低酸素血症、ニトログリセリンは血圧と禁忌を確認した虚血症状、モルヒネは難治性疼痛に限って用いる。

EnglishQuestion: Which variables are used in the GRACE score?
JapaneseQuestion: GRACEスコアに用いる変数は？
EnglishAnswer: Age, heart rate, systolic blood pressure, creatinine, heart failure or Killip class III/IV, cardiac arrest around admission, ST changes, and cardiac biomarker changes.
JapaneseAnswer: 年齢、心拍数、収縮期血圧、クレアチニン、心不全またはKillip III/IV、入院前後の心停止、ST変化、心筋バイオマーカー変化。

EnglishQuestion: What outcome does the GRACE score estimate in acute coronary syndrome?
JapaneseQuestion: 急性冠症候群でGRACEスコアは何を推定するか？
EnglishAnswer: Six-month mortality risk.
JapaneseAnswer: 6か月死亡リスク。

EnglishQuestion: Which findings define very-high-risk NSTE-ACS requiring an immediate invasive strategy?
JapaneseQuestion: 即時侵襲的戦略を要する超高リスクNSTE-ACSの所見は？
EnglishAnswer: Hemodynamic instability or shock; refractory or recurrent chest pain; life-threatening arrhythmia or cardiac arrest; acute heart failure due to ACS; mechanical complications; or recurrent dynamic ST-T changes, especially transient ST elevation.
JapaneseAnswer: 血行動態不安定またはショック、治療抵抗性・反復性胸痛、致死性不整脈または心停止、ACSによる急性心不全、機械的合併症、反復する動的ST-T変化、特に一過性ST上昇。

EnglishQuestion: When should coronary angiography be performed in very-high-risk NSTE-ACS?
JapaneseQuestion: 超高リスクNSTE-ACSでは冠動脈造影をいつ行うか？
EnglishAnswer: Immediately, as soon as possible.
JapaneseAnswer: 直ちに、可能な限り早く行う。

EnglishQuestion: Which high-risk NSTE-ACS findings support considering angiography within 24 hours?
JapaneseQuestion: 24時間以内の冠動脈造影を検討する高リスクNSTE-ACS所見は？
EnglishAnswer: GRACE score >140, dynamic ST-T changes, transient ST elevation, or other high-risk features in confirmed NSTE-ACS.
JapaneseAnswer: 確定NSTE-ACSにおけるGRACEスコア140超、動的ST-T変化、一過性ST上昇、その他の高リスク所見。

EnglishQuestion: What invasive strategy is used for confirmed NSTE-ACS that does not meet immediate or early criteria?
JapaneseQuestion: 即時・早期基準を満たさない確定NSTE-ACSでは、どの侵襲的戦略を用いるか？
EnglishAnswer: An invasive strategy during the same hospitalization, individualized according to the clinical course, comorbidities, anatomy, and bleeding risk.
JapaneseAnswer: 臨床経過、併存疾患、解剖、出血リスクに応じて個別化した入院中の侵襲的戦略。

EnglishQuestion: What is the management approach when ACS likelihood is low and no high-risk features are present?
JapaneseQuestion: ACSの可能性が低く高リスク所見がない場合の管理方針は？
EnglishAnswer: Use a selective strategy and reassess, including noninvasive testing when appropriate.
JapaneseAnswer: 選択的戦略とし、必要に応じて非侵襲的検査を含め再評価する。

EnglishQuestion: What is the risk-guided flow from NSTE-ACS diagnosis to coronary angiography?
JapaneseQuestion: NSTE-ACS診断から冠動脈造影までのリスクに基づく流れは？
EnglishAnswer: Diagnose NSTE-ACS and start initial treatment -> assess GRACE score and clinical findings -> very high risk: immediate angiography; high risk: consider angiography within 24 hours; other confirmed cases: invasive strategy during hospitalization.
JapaneseAnswer: NSTE-ACSを診断し初期治療開始→GRACEスコアと臨床所見を評価→超高リスク：即時造影、高リスク：24時間以内を検討、その他の確定例：入院中の侵襲的戦略。

EnglishQuestion: Which factors should guide the choice between PCI and CABG after angiography?
JapaneseQuestion: 造影後のPCIとCABGの選択を導く要因は？
EnglishAnswer: The culprit lesion, left main disease, multivessel disease, anatomic complexity, diabetes, left ventricular function, surgical risk, and patient preference.
JapaneseAnswer: 責任病変、左主幹部病変、多枝病変、解剖学的複雑性、糖尿病、左室機能、手術リスク、患者希望。

EnglishQuestion: Why should the choice between PCI and CABG not be based only on the number of diseased vessels?
JapaneseQuestion: PCIとCABGの選択を病変枝数だけで決めてはいけないのはなぜか？
EnglishAnswer: Revascularization must integrate lesion anatomy, clinical risk, ventricular function, comorbidities, surgical risk, and patient preference.
JapaneseAnswer: 血行再建は病変解剖、臨床リスク、心室機能、併存疾患、手術リスク、患者希望を統合して決めるため。

EnglishQuestion: What does dual antiplatelet therapy (DAPT) consist of in NSTE-ACS?
JapaneseQuestion: NSTE-ACSにおける二剤抗血小板療法（DAPT）は何から成るか？
EnglishAnswer: Aspirin plus a P2Y12 inhibitor.
JapaneseAnswer: アスピリンとP2Y12阻害薬。

EnglishQuestion: Which factors should individualize the P2Y12 inhibitor and duration of DAPT?
JapaneseQuestion: P2Y12阻害薬の選択とDAPT期間を個別化する要因は？
EnglishAnswer: The invasive strategy, bleeding risk, age, and other clinical factors.
JapaneseAnswer: 侵襲的戦略、出血リスク、年齢、その他の臨床要因。

EnglishQuestion: Which drug classes are central to antithrombotic and secondary-prevention therapy after NSTE-ACS?
JapaneseQuestion: NSTE-ACS後の抗血栓療法と二次予防の中心となる薬剤群は？
EnglishAnswer: Anticoagulation such as heparin, DAPT, a beta-blocker, an ACE inhibitor, and a statin, individualized to hemodynamics, renal function, bleeding risk, and the invasive plan.
JapaneseAnswer: ヘパリンなどの抗凝固薬、DAPT、β遮断薬、ACE阻害薬、スタチンを、血行動態、腎機能、出血リスク、侵襲的治療計画に応じて個別化する。

EnglishQuestion: When should mobilization and cardiac rehabilitation begin after NSTE-ACS?
JapaneseQuestion: NSTE-ACS後、離床と心臓リハビリテーションはいつ開始するか？
EnglishAnswer: Begin early when hemodynamics and the vascular access site are stable.
JapaneseAnswer: 血行動態と穿刺部が安定したら早期に開始する。

EnglishQuestion: What additional measures are important after stabilization from NSTE-ACS?
JapaneseQuestion: NSTE-ACS安定化後に重要な追加対策は？
EnglishAnswer: Repeat ECG and biomarkers as clinically indicated, prevent thromboembolism, correct modifiable risk factors, provide advice about work and sexual activity, and arrange exercise testing or rehabilitation as appropriate.
JapaneseAnswer: 臨床経過に応じた心電図・バイオマーカー再検、血栓塞栓予防、修正可能な危険因子の是正、仕事・性生活への助言、適切な運動負荷検査またはリハビリテーション。

EnglishQuestion: What clinical and ECG findings establish the working diagnosis of STEMI?
JapaneseQuestion: STEMIの作業診断を確立する臨床所見と心電図所見は？
EnglishAnswer: Ischemic symptoms with persistent diagnostic ST-segment elevation in contiguous leads.
JapaneseAnswer: 虚血症状と、隣接誘導における診断基準を満たす持続性ST上昇。

EnglishQuestion: What is the usual pathophysiologic sequence leading to STEMI?
JapaneseQuestion: STEMIに至る典型的な病態生理の流れは？
EnglishAnswer: Atherosclerotic plaque formation -> plaque rupture or erosion -> exposure of a thrombogenic surface -> thrombus formation -> abrupt severe reduction or occlusion of coronary flow -> myocardial ischemia -> myocyte death without reperfusion.
JapaneseAnswer: 動脈硬化性プラーク形成→破裂またはびらん→血栓形成性表面の露出→血栓形成→冠血流の急激な高度低下または閉塞→心筋虚血→再灌流がなければ心筋細胞死。

EnglishQuestion: Must complete coronary occlusion or completed transmural infarction be proven before diagnosing and treating STEMI?
JapaneseQuestion: STEMIの診断・治療前に、完全冠閉塞または完成した貫壁性梗塞を証明する必要があるか？
EnglishAnswer: No. Neither is required at the time of diagnosis; reperfusion should proceed immediately when the clinical and ECG criteria are met.
JapaneseAnswer: 必要ない。診断時点ではどちらも必須ではなく、臨床・心電図基準を満たせば直ちに再灌流を進める。

EnglishQuestion: What is the principal cause of the high prehospital mortality in STEMI?
JapaneseQuestion: STEMIの高い院外死亡率の主因は？
EnglishAnswer: Ventricular fibrillation.
JapaneseAnswer: 心室細動。

EnglishQuestion: Approximately what proportion of patients with STEMI may die before reaching the hospital?
JapaneseQuestion: STEMI患者のうち院外で死亡し得る割合は約どの程度か？
EnglishAnswer: Approximately 30-50%.
JapaneseAnswer: 約30〜50%。

EnglishQuestion: Should reperfusion in a patient with a STEMI working diagnosis wait for cardiac biomarker results?
JapaneseQuestion: STEMIの作業診断がある患者で、再灌流を心筋バイオマーカー結果まで待つべきか？
EnglishAnswer: No. Reperfusion must not be delayed while awaiting biomarkers.
JapaneseAnswer: 待つべきではない。バイオマーカー結果を待って再灌流を遅らせない。

EnglishQuestion: Is new or previously unknown left or right bundle branch block alone sufficient to diagnose STEMI?
JapaneseQuestion: 新規または既知でない左脚・右脚ブロックだけでSTEMIと診断できるか？
EnglishAnswer: No. Symptoms, concordant ST changes, previous ECGs, and urgent echocardiography must be integrated.
JapaneseAnswer: できない。症状、一致性ST変化、過去の心電図、緊急心エコーを統合する必要がある。

EnglishQuestion: When should urgent coronary angiography be considered in a patient with bundle branch block?
JapaneseQuestion: 脚ブロック患者で緊急冠動脈造影をいつ検討するか？
EnglishAnswer: When persistent myocardial ischemia is strongly suspected after integrating symptoms, ECG concordance, previous ECGs, and urgent imaging.
JapaneseAnswer: 症状、心電図の一致性、過去心電図、緊急画像を統合して持続性心筋虚血が強く疑われる場合。

EnglishQuestion: Which cardiac biomarker is central to STEMI evaluation?
JapaneseQuestion: STEMI評価の中心となる心筋バイオマーカーは？
EnglishAnswer: High-sensitivity cardiac troponin (hs-cTn).
JapaneseAnswer: 高感度心筋トロポニン（hs-cTn）。

EnglishQuestion: In which selected situation can CK-MB be useful after myocardial infarction?
JapaneseQuestion: 心筋梗塞後、CK-MBが有用となり得る選択された状況は？
EnglishAnswer: Evaluation for reinfarction.
JapaneseAnswer: 再梗塞の評価。

EnglishQuestion: What does the phrase "Time is myocardium, time is life" emphasize in STEMI?
JapaneseQuestion: STEMIにおける「Time is myocardium, time is life」は何を強調するか？
EnglishAnswer: Reperfusion must begin without delay to preserve salvageable myocardium and life.
JapaneseAnswer: 救済可能な心筋と生命を守るため、再灌流を遅滞なく開始すべきこと。

EnglishQuestion: What is the central reperfusion time window after symptom onset in STEMI, and how should it be interpreted?
JapaneseQuestion: STEMI発症後の中心的な再灌流適応時間窓はどの程度で、どう解釈するか？
EnglishAnswer: Within 12 hours, but this does not mean treatment may wait; reperfusion should start immediately after diagnosis.
JapaneseAnswer: 12時間以内だが、待ってよいという意味ではなく、診断後直ちに再灌流を開始する。

EnglishQuestion: Name five important differential diagnoses of STEMI-like chest pain.
JapaneseQuestion: STEMI様胸痛の重要な鑑別診断を5つ挙げよ。
EnglishAnswer: Pulmonary embolism, aortic dissection, pleuritis, gastroesophageal reflux disease, and myositis.
JapaneseAnswer: 肺塞栓症、大動脈解離、胸膜炎、胃食道逆流症、筋炎。

EnglishQuestion: Why is aortic dissection a critical alternative diagnosis in suspected STEMI?
JapaneseQuestion: STEMI疑いで大動脈解離が重要な代替診断なのはなぜか？
EnglishAnswer: It can mimic acute coronary ischemia and would make thrombolytic treatment dangerous.
JapaneseAnswer: 急性冠虚血に類似し、血栓溶解療法が危険となるため。

EnglishQuestion: What should happen immediately after a STEMI working diagnosis is made?
JapaneseQuestion: STEMIの作業診断後、直ちに何を行うべきか？
EnglishAnswer: Activate urgent reperfusion of the culprit coronary artery while continuing rapid clinical assessment and treatment.
JapaneseAnswer: 迅速な臨床評価と治療を続けながら、責任冠動脈の緊急再灌流を開始する。

EnglishQuestion: What is the preferred reperfusion strategy for STEMI when it can be performed promptly?
JapaneseQuestion: 迅速に実施可能な場合、STEMIで優先する再灌流戦略は？
EnglishAnswer: Primary percutaneous coronary intervention (PCI).
JapaneseAnswer: 一次経皮的冠動脈インターベンション（PCI）。

EnglishQuestion: What should be confirmed immediately after diagnosing STEMI?
JapaneseQuestion: STEMI診断直後に確認すべきことは？
EnglishAnswer: The time of symptom onset, the expected time to PCI reperfusion, and contraindications to treatment.
JapaneseAnswer: 症状発現時刻、PCI再灌流までの予測時間、治療禁忌。

EnglishQuestion: Why should the classic MONA/BASC mnemonic not be applied indiscriminately in STEMI?
JapaneseQuestion: STEMIで古典的なMONA/BASCを一律に適用してはいけないのはなぜか？
EnglishAnswer: Each component has a specific indication and contraindication; not every patient should receive every drug.
JapaneseAnswer: 各成分に固有の適応と禁忌があり、全患者に全薬剤を投与すべきではないため。

EnglishQuestion: When are oxygen, morphine, and nitroglycerin used in STEMI?
JapaneseQuestion: STEMIで酸素、モルヒネ、ニトログリセリンはいつ用いるか？
EnglishAnswer: Oxygen for hypoxemia; morphine for refractory pain; nitroglycerin only after checking blood pressure and contraindications.
JapaneseAnswer: 酸素は低酸素血症、モルヒネは難治性疼痛、ニトログリセリンは血圧と禁忌を確認した場合に用いる。

EnglishQuestion: Which factors guide selection and dosing of a P2Y12 inhibitor in STEMI?
JapaneseQuestion: STEMIでP2Y12阻害薬の選択と用量を決める要因は？
EnglishAnswer: The reperfusion method, patient age, and bleeding risk.
JapaneseAnswer: 再灌流法、患者年齢、出血リスク。

EnglishQuestion: What is the key time threshold for choosing primary PCI versus fibrinolysis in STEMI?
JapaneseQuestion: STEMIで一次PCIと血栓溶解療法を選ぶ際の重要な時間閾値は？
EnglishAnswer: Whether PCI-mediated reperfusion can be achieved within 120 minutes of diagnosis.
JapaneseAnswer: 診断から120分以内にPCIによる再灌流が可能かどうか。

EnglishQuestion: What is the reperfusion flow when STEMI is diagnosed?
JapaneseQuestion: STEMI診断時の再灌流の流れは？
EnglishAnswer: Confirm onset time and contraindications -> if PCI reperfusion is possible within 120 minutes, perform primary PCI -> if not, and symptoms began within 12 hours with no contraindication, give immediate fibrinolysis and transfer to a PCI center.
JapaneseAnswer: 発症時刻と禁忌を確認→120分以内にPCI再灌流可能なら一次PCI→不可能で発症12時間以内かつ禁忌なしなら直ちに血栓溶解療法を行いPCI施設へ搬送。

EnglishQuestion: What are the core indications for fibrinolysis in STEMI?
JapaneseQuestion: STEMIで血栓溶解療法を行う中心的な適応は？
EnglishAnswer: Persistent ischemic symptoms with diagnostic ST elevation within 12 hours of onset, when timely primary PCI is unavailable and no contraindication exists.
JapaneseAnswer: 発症12時間以内の持続する虚血症状と診断的ST上昇があり、適時の一次PCIが不可能で禁忌がない場合。

EnglishQuestion: What should occur simultaneously with fibrinolysis for STEMI?
JapaneseQuestion: STEMIで血栓溶解療法と同時に何を行うか？
EnglishAnswer: Transfer the patient to a PCI-capable center.
JapaneseAnswer: PCI実施可能施設へ搬送する。

EnglishQuestion: Which findings after fibrinolysis require emergency rescue PCI?
JapaneseQuestion: 血栓溶解療法後、緊急レスキューPCIを要する所見は？
EnglishAnswer: Insufficient resolution of ST elevation, persistent chest pain, recurrent ischemia, or hemodynamic or electrical instability.
JapaneseAnswer: ST上昇の改善不十分、胸痛持続、再虚血、血行動態または電気的不安定。

EnglishQuestion: What should be done after apparently successful fibrinolysis?
JapaneseQuestion: 血栓溶解療法が成功した後に何を行うか？
EnglishAnswer: Plan early coronary angiography and PCI when indicated.
JapaneseAnswer: 早期冠動脈造影と、必要に応じたPCIを計画する。

EnglishQuestion: What is the pharmaco-invasive strategy in STEMI?
JapaneseQuestion: STEMIにおける薬物侵襲的戦略とは？
EnglishAnswer: Immediate fibrinolysis when timely PCI is unavailable, transfer to a PCI center, rescue PCI if reperfusion fails, and early angiography even when fibrinolysis succeeds.
JapaneseAnswer: 適時PCIが不可能な場合に直ちに血栓溶解療法を行いPCI施設へ搬送し、不成功ならレスキューPCI、成功しても早期造影を行う戦略。

EnglishQuestion: Name major absolute contraindications to fibrinolysis in suspected STEMI.
JapaneseQuestion: STEMI疑いで血栓溶解療法の主な絶対禁忌を挙げよ。
EnglishAnswer: Suspected aortic dissection, previous intracranial hemorrhage, active bleeding, and recent intracranial or spinal surgery or serious head trauma; the full checklist must be reviewed.
JapaneseAnswer: 大動脈解離疑い、頭蓋内出血既往、活動性出血、最近の頭蓋内・脊髄手術または重篤な頭部外傷。実施前に全禁忌チェックリストを確認する。

EnglishQuestion: Why is fibrinolysis dangerous when aortic dissection is suspected?
JapaneseQuestion: 大動脈解離が疑われる場合、血栓溶解療法が危険なのはなぜか？
EnglishAnswer: It can cause catastrophic bleeding and worsen the dissection.
JapaneseAnswer: 致命的出血を起こし、解離を悪化させ得るため。

EnglishQuestion: Does new or presumed-new left bundle branch block alone establish an indication for fibrinolysis?
JapaneseQuestion: 新規または推定新規左脚ブロックだけで血栓溶解療法の適応を確定できるか？
EnglishAnswer: No. Integrate the clinical picture, previous ECGs, Sgarbossa criteria, urgent imaging, and coronary angiography.
JapaneseAnswer: できない。臨床像、過去心電図、Sgarbossa基準、緊急画像、冠動脈造影を統合する。

EnglishQuestion: When should early mobilization and cardiac rehabilitation begin after STEMI reperfusion?
JapaneseQuestion: STEMI再灌流後、早期離床と心臓リハビリテーションはいつ開始するか？
EnglishAnswer: When hemodynamics and the vascular access site are stable.
JapaneseAnswer: 血行動態と穿刺部が安定したとき。

EnglishQuestion: When is long-term oral anticoagulation such as warfarin indicated after STEMI?
JapaneseQuestion: STEMI後、ワルファリンなどの長期経口抗凝固が適応となるのはいつか？
EnglishAnswer: Only when a separate indication exists, such as atrial fibrillation, left ventricular thrombus, or a mechanical valve.
JapaneseAnswer: 心房細動、左室血栓、機械弁など別の適応がある場合に限る。

EnglishQuestion: Which therapies are central to post-STEMI antithrombotic treatment and secondary prevention?
JapaneseQuestion: STEMI後の抗血栓療法と二次予防の中心となる治療は？
EnglishAnswer: DAPT and acute-phase anticoagulation according to reperfusion and bleeding risk, plus a beta-blocker, an ACE inhibitor, and a statin.
JapaneseAnswer: 再灌流法と出血リスクに応じたDAPTと急性期抗凝固に加え、β遮断薬、ACE阻害薬、スタチン。

EnglishQuestion: What does cardiac catheterization directly evaluate?
JapaneseQuestion: 心臓カテーテル検査は何を直接評価するか？
EnglishAnswer: Intracardiac and vascular pressures, blood flow, and cardiovascular anatomy, with treatment performed during the same procedure when indicated.
JapaneseAnswer: 心腔・血管内圧、血流、心血管形態を直接評価し、適応があれば同時に治療する。

EnglishQuestion: Which arterial access sites are used for left heart catheterization?
JapaneseQuestion: 左心カテーテル検査で用いる動脈アクセス部位は？
EnglishAnswer: The femoral, radial, or brachial artery.
JapaneseAnswer: 大腿動脈、橈骨動脈、または上腕動脈。

EnglishQuestion: What structures and measurements are evaluated by left heart catheterization?
JapaneseQuestion: 左心カテーテル検査で評価する構造と測定項目は？
EnglishAnswer: The aorta, coronary arteries, and left ventricle across the aortic valve; coronary anatomy, aortic pressure, and left ventricular pressure and function.
JapaneseAnswer: 大動脈、冠動脈、大動脈弁を越えた左室、ならびに冠動脈解剖、大動脈圧、左室圧・機能。

EnglishQuestion: Which venous access sites are used for right heart catheterization?
JapaneseQuestion: 右心カテーテル検査で用いる静脈アクセス部位は？
EnglishAnswer: The femoral, subclavian, or antecubital vein.
JapaneseAnswer: 大腿静脈、鎖骨下静脈、または肘窩静脈。

EnglishQuestion: What structures and measurements are evaluated by right heart catheterization?
JapaneseQuestion: 右心カテーテル検査で評価する構造と測定項目は？
EnglishAnswer: The right atrium, right ventricle, tricuspid valve, pulmonary valve, and pulmonary artery; right-sided and pulmonary artery pressures and pulmonary vascular resistance.
JapaneseAnswer: 右房、右室、三尖弁、肺動脈弁、肺動脈、ならびに右心系・肺動脈圧と肺血管抵抗。

EnglishQuestion: How do left and right heart catheterization differ in access and main targets?
JapaneseQuestion: 左心カテーテルと右心カテーテルは、アクセスと主な評価対象がどう異なるか？
EnglishAnswer: Left catheterization uses arterial access to assess the aorta, coronaries, and left ventricle; right catheterization uses venous access to assess the right heart, pulmonary artery pressures, and pulmonary vascular resistance.
JapaneseAnswer: 左心は動脈アクセスで大動脈・冠動脈・左室を評価し、右心は静脈アクセスで右心系、肺動脈圧、肺血管抵抗を評価する。

EnglishQuestion: How can the transmitral pressure gradient be assessed invasively?
JapaneseQuestion: 僧帽弁通過圧較差を侵襲的にどう評価するか？
EnglishAnswer: Compare transseptal left atrial pressure or pulmonary artery wedge pressure with left ventricular pressure.
JapaneseAnswer: 経中隔左房圧または肺動脈楔入圧と左室圧を比較する。

EnglishQuestion: Name major diagnostic and therapeutic uses of cardiac catheterization.
JapaneseQuestion: 心臓カテーテル検査の主な診断・治療用途を挙げよ。
EnglishAnswer: Pressure-gradient and coronary-flow assessment, angiography, PCI, valvuloplasty, myocardial biopsy, atherectomy, intravascular ultrasound, and pericardiocentesis.
JapaneseAnswer: 圧較差・冠血流評価、血管造影、PCI、弁形成術、心筋生検、アテレクトミー、血管内超音波、心嚢穿刺。

EnglishQuestion: Why must the guidewire be retained during the Seldinger technique?
JapaneseQuestion: セルジンガー法でガイドワイヤーを保持するのはなぜか？
EnglishAnswer: To avoid losing vascular access.
JapaneseAnswer: 血管アクセスを失わないため。

EnglishQuestion: What are major complications of cardiac catheterization?
JapaneseQuestion: 心臓カテーテル検査の主な合併症は？
EnglishAnswer: Bleeding, pseudoaneurysm, tamponade, contrast hypersensitivity, arrhythmia, thrombosis, stroke, acute myocardial infarction, angina, and infection.
JapaneseAnswer: 出血、仮性動脈瘤、心タンポナーデ、造影剤過敏、 不整脈、血栓症、脳卒中、急性心筋梗塞、狭心症、感染。

EnglishQuestion: What are relative contraindications to cardiac catheterization?
JapaneseQuestion: 心臓カテーテル検査の相対禁忌は？
EnglishAnswer: Renal failure, coagulopathy, fever or systemic infection, uncontrolled arrhythmia, decompensated heart failure, and contrast allergy.
JapaneseAnswer: 腎不全、凝固障害、発熱または全身感染、制御不能な不整脈、非代償性心不全、造影剤アレルギー。

EnglishQuestion: What is the approximate formula for mean arterial pressure?
JapaneseQuestion: 平均動脈圧の近似式は？
EnglishAnswer: MAP = (SBP + 2 x DBP) / 3.
JapaneseAnswer: 平均動脈圧＝（収縮期血圧＋2×拡張期血圧）÷3。

EnglishQuestion: What does a left ventricular ejection fraction below 40% indicate?
JapaneseQuestion: 左室駆出率40%未満は何を示すか？
EnglishAnswer: Reduced left ventricular systolic function.
JapaneseAnswer: 左室収縮機能低下。

EnglishQuestion: Why can heart failure not be diagnosed from ejection fraction alone?
JapaneseQuestion: 駆出率だけで心不全を診断できないのはなぜか？
EnglishAnswer: Diagnosis requires integration of symptoms, signs, structural abnormalities, filling pressures, and biomarkers.
JapaneseAnswer: 症状、徴候、構造異常、充満圧、バイオマーカーを統合する必要があるため。

EnglishQuestion: What does a Wiggers diagram display on a common time axis?
JapaneseQuestion: Wiggers図は同一時間軸上に何を表示するか？
EnglishAnswer: The ECG, left ventricular, aortic, and left atrial pressures, left ventricular volume, and heart sounds.
JapaneseAnswer: 心電図、左室・大動脈・左房圧、左室容積、心音。

EnglishQuestion: What occurs during atrial systole in the cardiac cycle?
JapaneseQuestion: 心周期の心房収縮期に何が起こるか？
EnglishAnswer: After the P wave, the AV valves are open and semilunar valves closed; atrial contraction produces the a wave and completes ventricular filling to end-diastolic volume.
JapaneseAnswer: P波後、房室弁が開き半月弁は閉じ、心房収縮でa波が生じ、心室充満が拡張末期容積まで完了する。

EnglishQuestion: What occurs during isovolumetric contraction?
JapaneseQuestion: 等容性収縮期に何が起こるか？
EnglishAnswer: After the QRS complex, the AV valves close, producing S1; all valves are closed, ventricular pressure rises rapidly, and ventricular volume remains constant.
JapaneseAnswer: QRS後に房室弁が閉じS1が生じ、全弁閉鎖のまま心室圧が急上昇し、心室容積は一定。

EnglishQuestion: What opens the semilunar valves and initiates ventricular ejection?
JapaneseQuestion: 半月弁を開き心室駆出を開始させるものは？
EnglishAnswer: Ventricular pressure exceeding aortic or pulmonary artery pressure.
JapaneseAnswer: 心室圧が大動脈圧または肺動脈圧を上回ること。

EnglishQuestion: What occurs during isovolumetric relaxation?
JapaneseQuestion: 等容性弛緩期に何が起こるか？
EnglishAnswer: After the T wave, semilunar valve closure produces S2 and the aortic dicrotic notch; all valves are closed, ventricular pressure falls rapidly, and volume remains constant.
JapaneseAnswer: T波後、半月弁閉鎖でS2と大動脈切痕が生じ、全弁閉鎖のまま心室圧が急低下し、容積は一定。

EnglishQuestion: What pressure relationship opens the AV valves and begins ventricular filling?
JapaneseQuestion: 房室弁を開き心室充満を開始させる圧関係は？
EnglishAnswer: Atrial pressure exceeding ventricular pressure.
JapaneseAnswer: 心房圧が心室圧を上回ること。

EnglishQuestion: What do the left atrial a, c, and v waves represent?
JapaneseQuestion: 左房圧のa波、c波、v波はそれぞれ何を表すか？
EnglishAnswer: The a wave is atrial contraction; the c wave is mitral valve bulging during early isovolumetric contraction; the v wave is left atrial filling while the mitral valve is closed.
JapaneseAnswer: a波は心房収縮、c波は等容性収縮初期の僧帽弁膨隆、v波は僧帽弁閉鎖中の左房充満。

EnglishQuestion: When can S3 and S4 occur during the cardiac cycle?
JapaneseQuestion: 心周期でS3とS4はいつ生じ得るか？
EnglishAnswer: S3 may occur during rapid filling with volume overload; S4 may occur during atrial systole when the ventricle is pathologically stiff.
JapaneseAnswer: S3は容量負荷時の急速充満期、S4は病的に硬い心室への心房収縮時に生じ得る。

EnglishQuestion: What does the dicrotic notch represent?
JapaneseQuestion: 大動脈圧波形の切痕は何を表すか？
EnglishAnswer: Semilunar valve closure.
JapaneseAnswer: 半月弁閉鎖。

EnglishQuestion: Why does ventricular volume remain unchanged during isovolumetric contraction and relaxation?
JapaneseQuestion: 等容性収縮期と等容性弛緩期に心室容積が変わらないのはなぜか？
EnglishAnswer: All valves are closed, so pressure changes without blood entering or leaving the ventricle.
JapaneseAnswer: 全弁が閉鎖しており、血液が心室へ出入りせず圧だけが変化するため。

EnglishQuestion: What is the sequence of valve events in one cardiac cycle?
JapaneseQuestion: 1心周期における弁イベントの流れは？
EnglishAnswer: Atrial contraction and filling -> AV valve closure with S1 -> semilunar valve opening and ejection -> semilunar valve closure with S2 -> isovolumetric relaxation -> AV valve opening and filling.
JapaneseAnswer: 心房収縮・充満→房室弁閉鎖とS1→半月弁開放・駆出→半月弁閉鎖とS2→等容性弛緩→房室弁開放・充満。

EnglishQuestion: What is percutaneous coronary intervention (PCI)?
JapaneseQuestion: 経皮的冠動脈インターベンション（PCI）とは？
EnglishAnswer: Catheter-based revascularization that dilates a stenotic coronary artery with a balloon and, when needed, maintains patency with a stent.
JapaneseAnswer: カテーテルで狭窄冠動脈をバルーン拡張し、必要に応じてステントで開存を維持する血行再建術。

EnglishQuestion: What are major acute coronary indications for PCI?
JapaneseQuestion: PCIの主な急性冠動脈適応は？
EnglishAnswer: Primary PCI for STEMI and revascularization of the culprit lesion when an invasive strategy is indicated in NSTE-ACS.
JapaneseAnswer: STEMIの一次PCIと、NSTE-ACSで侵襲的戦略が適応となる責任病変の血行再建。

EnglishQuestion: What other coronary lesions or clinical situations can indicate PCI?
JapaneseQuestion: PCIが適応となり得るその他の冠動脈病変・臨床状況は？
EnglishAnswer: Acute or chronic coronary occlusion, bypass-graft or stent occlusion, recurrent ischemia after PCI or CABG, and symptomatic coronary artery disease.
JapaneseAnswer: 急性・慢性冠閉塞、バイパスグラフトまたはステント閉塞、PCI・CABG後の反復虚血、症候性冠動脈疾患。

EnglishQuestion: Which symptoms may improve after PCI for coronary artery disease?
JapaneseQuestion: 冠動脈疾患に対するPCIで改善し得る症状は？
EnglishAnswer: Angina, dyspnea, congestive heart failure symptoms, and symptoms of acute myocardial infarction.
JapaneseAnswer: 狭心症、呼吸困難、うっ血性心不全症状、急性心筋梗塞症状。

EnglishQuestion: What is the procedural sequence of PCI?
JapaneseQuestion: PCIの手技の流れは？
EnglishAnswer: Puncture a radial, femoral, or brachial artery -> insert a guidewire by the Seldinger technique -> place an introducer sheath -> advance a guiding catheter under fluoroscopy -> pass a balloon over the wire to the stenosis -> inflate the balloon -> place a stent if needed.
JapaneseAnswer: 橈骨・大腿・上腕動脈を穿刺→セルジンガー法でガイドワイヤー挿入→イントロデューサーシース留置→透視下にガイディングカテーテルを進める→ワイヤーに沿ってバルーンを狭窄部へ→拡張→必要時ステント留置。

EnglishQuestion: Why can a coronary artery narrow again after balloon angioplasty alone?
JapaneseQuestion: バルーン血管形成術だけでは冠動脈が再び狭窄し得るのはなぜか？
EnglishAnswer: Elastic recoil or coronary dissection can reduce the lumen after dilation.
JapaneseAnswer: 拡張後の弾性収縮または冠動脈解離で内腔が再狭窄し得るため。

EnglishQuestion: How does a stent maintain coronary artery patency?
JapaneseQuestion: ステントはどのように冠動脈の開存を維持するか？
EnglishAnswer: It leaves an expanded metal scaffold that mechanically supports the vessel wall.
JapaneseAnswer: 拡張した金属製足場を残して血管壁を機械的に支持する。

EnglishQuestion: How do bare-metal and drug-eluting stents differ?
JapaneseQuestion: ベアメタルステントと薬剤溶出性ステントはどう異なるか？
EnglishAnswer: Both limit acute recoil, but drug-eluting stents suppress inflammation and neointimal proliferation and therefore reduce restenosis more effectively.
JapaneseAnswer: どちらも急性収縮を抑えるが、薬剤溶出性ステントは炎症と新生内膜増殖を抑え、再狭窄をより減少させる。

EnglishQuestion: Which drugs are examples of agents used in drug-eluting stents?
JapaneseQuestion: 薬剤溶出性ステントに用いる薬剤の例は？
EnglishAnswer: Sirolimus and everolimus.
JapaneseAnswer: シロリムスとエベロリムス。

EnglishQuestion: Why is antiplatelet therapy required after coronary stent placement?
JapaneseQuestion: 冠動脈ステント留置後に抗血小板療法が必要なのはなぜか？
EnglishAnswer: To prevent stent thrombosis.
JapaneseAnswer: ステント血栓症を予防するため。

EnglishQuestion: Which factors determine the duration of antiplatelet therapy after stent placement?
JapaneseQuestion: ステント留置後の抗血小板療法期間を決める要因は？
EnglishAnswer: Whether the presentation was ACS or stable coronary disease, bleeding risk, and stent- and procedure-related factors.
JapaneseAnswer: ACSか安定冠動脈疾患か、出血リスク、ステント・手技関連因子。

EnglishQuestion: What are the main advantages of PCI?
JapaneseQuestion: PCIの主な利点は？
EnglishAnswer: It avoids open-chest surgery, is less invasive, and generally allows a shorter hospital stay and recovery.
JapaneseAnswer: 開胸手術を回避でき、低侵襲で、一般に入院・回復期間が短い。

EnglishQuestion: What are common vascular-access complications of PCI?
JapaneseQuestion: PCIの一般的な血管アクセス合併症は？
EnglishAnswer: Bleeding, bruising, and hematoma at the puncture site.
JapaneseAnswer: 穿刺部の出血、皮下出血、血腫。

EnglishQuestion: What are important coronary complications of PCI?
JapaneseQuestion: PCIの重要な冠動脈合併症は？
EnglishAnswer: Restenosis, coronary dissection or perforation, and stent thrombosis.
JapaneseAnswer: 再狭窄、冠動脈解離または穿孔、ステント血栓症。

EnglishQuestion: What noncoronary complications should be monitored after PCI?
JapaneseQuestion: PCI後に監視すべき冠動脈以外の合併症は？
EnglishAnswer: Recurrent angina, access-site bleeding or hematoma, and contrast allergy.
JapaneseAnswer: 反復性狭心症、穿刺部出血・血腫、造影剤アレルギー。

EnglishQuestion: Which six immediately life-threatening diagnoses should be prioritized in acute chest pain?
JapaneseQuestion: 急性胸痛で直ちに優先すべき6つの致死的診断は？
EnglishAnswer: Acute coronary syndrome, aortic dissection, pulmonary embolism, tension pneumothorax, esophageal rupture, and perforated peptic ulcer.
JapaneseAnswer: 急性冠症候群、大動脈解離、肺塞栓症、緊張性気胸、食道破裂、消化性潰瘍穿孔。

EnglishQuestion: Why should the severity of chest pain not determine diagnostic priority?
JapaneseQuestion: 胸痛の強さだけで診断の優先順位を決めてはいけないのはなぜか？
EnglishAnswer: Pain intensity does not reliably reflect lethality; time-critical life-threatening causes must be excluded first.
JapaneseAnswer: 痛みの強さは生命危険度を正確に反映しないため、時間依存性の致死的原因を先に除外する。

EnglishQuestion: Which important diagnoses can cause retrosternal chest pain?
JapaneseQuestion: 胸骨後部痛を起こす重要な疾患は？
EnglishAnswer: Myocardial ischemia, pericardial or esophageal pain, aortic dissection, mediastinal lesions, and pulmonary embolism.
JapaneseAnswer: 心筋虚血、心膜痛、食道痛、大動脈解離、縦隔病変、肺塞栓症。

EnglishQuestion: Which diagnoses should be reconsidered in epigastric or lower anterior chest pain?
JapaneseQuestion: 心窩部または前胸部下部の痛みで再検討すべき疾患は？
EnglishAnswer: Inferior myocardial infarction, pericardial or esophageal disease, peptic ulcer, pancreatitis, gallbladder disease, pneumonia, and pleurisy.
JapaneseAnswer: 下壁心筋梗塞、心膜・食道疾患、消化性潰瘍、膵炎、胆嚢疾患、肺炎、胸膜炎。

EnglishQuestion: What critical diagnosis should be prioritized with sudden tearing interscapular pain?
JapaneseQuestion: 突然の裂けるような肩甲間部痛で優先すべき重要診断は？
EnglishAnswer: Aortic dissection.
JapaneseAnswer: 大動脈解離。

EnglishQuestion: Which diagnoses should be reconsidered in pleuritic lateral chest pain?
JapaneseQuestion: 呼吸性の側胸部痛で再検討すべき疾患は？
EnglishAnswer: Pulmonary embolism and pneumothorax.
JapaneseAnswer: 肺塞栓症と気胸。

EnglishQuestion: What vital-sign or examination red flags indicate dangerous chest pain?
JapaneseQuestion: 危険な胸痛を示すバイタル・診察上のレッドフラッグは？
EnglishAnswer: Respiratory rate >24/min or accessory muscle use, altered consciousness, marked bradycardia or tachycardia, hypotension with cold peripheries, extreme hypertension, or oxygen saturation <90%.
JapaneseAnswer: 呼吸数24/分超または補助呼吸筋使用、意識低下、著しい徐脈・頻脈、末梢冷感を伴う低血圧、極端な高血圧、酸素飽和度90%未満。

EnglishQuestion: What symptom and ECG red flags indicate dangerous chest pain?
JapaneseQuestion: 危険な胸痛を示す症状・心電図上のレッドフラッグは？
EnglishAnswer: Persistent, worsening, or recurrent pain; diaphoresis or dyspnea; radiating pressure; ST elevation; ventricular tachycardia; or AV block.
JapaneseAnswer: 持続・増悪・反復する痛み、発汗または呼吸困難、放散する圧迫痛、ST上昇、心室頻拍、房室ブロック。

EnglishQuestion: What should occur immediately when chest-pain red flags are present?
JapaneseQuestion: 胸痛のレッドフラッグがある場合、直ちに何を行うか？
EnglishAnswer: Stabilize airway, breathing, and circulation while performing monitoring, a 12-lead ECG, and urgent imaging or reperfusion as indicated.
JapaneseAnswer: 気道・呼吸・循環を安定化しつつ、モニタリング、12誘導心電図、適応に応じた緊急画像または再灌流を並行する。

EnglishQuestion: What features suggest pulmonary embolism in a patient with chest pain?
JapaneseQuestion: 胸痛患者で肺塞栓症を示唆する所見は？
EnglishAnswer: Pleuritic stabbing pain, dyspnea, syncope, and tachycardia, often arising from deep vein thrombosis.
JapaneseAnswer: 呼吸性の刺す痛み、呼吸困難、失神、頻脈で、多くは深部静脈血栓症に由来する。

EnglishQuestion: What features suggest aortic dissection in a patient with chest pain?
JapaneseQuestion: 胸痛患者で大動脈解離を示唆する所見は？
EnglishAnswer: Tearing pain radiating to the back, migrating pain, pulse deficits, and neurologic deficits.
JapaneseAnswer: 背部へ放散する裂ける痛み、移動痛、脈拍左右差、神経症状。

EnglishQuestion: What findings suggest tension pneumothorax?
JapaneseQuestion: 緊張性気胸を示唆する所見は？
EnglishAnswer: Absent unilateral breath sounds, hypotension, jugular venous distension, and tracheal deviation.
JapaneseAnswer: 片側呼吸音消失、低血圧、頸静脈怒張、気管偏位。

EnglishQuestion: What is the immediate treatment of suspected tension pneumothorax?
JapaneseQuestion: 緊張性気胸疑いの直ちに行う治療は？
EnglishAnswer: Immediate needle decompression followed by tube thoracostomy; do not wait for imaging.
JapaneseAnswer: 画像を待たず直ちに針脱気し、その後胸腔ドレーンを留置する。

EnglishQuestion: What features suggest esophageal rupture?
JapaneseQuestion: 食道破裂を示唆する所見は？
EnglishAnswer: Severe pain after forceful vomiting or an iatrogenic procedure, mediastinal emphysema, and rapidly developing sepsis.
JapaneseAnswer: 激しい嘔吐または医原性手技後の激痛、縦隔気腫、急速に進行する敗血症。

EnglishQuestion: How are Stanford type A and type B aortic dissections distinguished?
JapaneseQuestion: Stanford A型とB型大動脈解離はどう区別するか？
EnglishAnswer: Type A includes the ascending aorta; type B does not include the ascending aorta and begins distal to the left subclavian artery.
JapaneseAnswer: A型は上行大動脈を含み、B型は上行大動脈を含まず左鎖骨下動脈より遠位から始まる。

EnglishQuestion: What is the general management difference between Stanford type A and uncomplicated type B aortic dissection?
JapaneseQuestion: Stanford A型と合併症のないB型大動脈解離の基本治療はどう異なるか？
EnglishAnswer: Type A generally requires emergency surgical assessment; uncomplicated type B is usually managed medically with blood-pressure control.
JapaneseAnswer: A型は原則緊急外科評価を要し、合併症のないB型は通常内科的降圧を基本とする。

EnglishQuestion: What Wells score values define low, moderate, and high pulmonary embolism probability in the three-level model?
JapaneseQuestion: Wellsスコアの3段階モデルで、肺塞栓症の低・中・高確率を示す値は？
EnglishAnswer: Low: <2; moderate: 2-6; high: >6.
JapaneseAnswer: 低確率：2未満、中確率：2〜6、高確率：6超。

EnglishQuestion: What are the highest-weighted items in the pulmonary embolism Wells score?
JapaneseQuestion: 肺塞栓症Wellsスコアで最も配点が高い項目は？
EnglishAnswer: Clinical signs of DVT and the judgment that PE is more likely than alternative diagnoses, each worth 3 points.
JapaneseAnswer: DVTの臨床徴候と、他の診断よりPEが疑わしいとの判断で、各3点。

EnglishQuestion: Why must aortic dissection be excluded before anticoagulation or fibrinolysis for chest pain?
JapaneseQuestion: 胸痛に対する抗凝固・血栓溶解前に大動脈解離を除外すべきなのはなぜか？
EnglishAnswer: Antithrombotic treatment can cause catastrophic bleeding if dissection is present.
JapaneseAnswer: 解離がある場合、抗血栓療法が致命的出血を起こし得るため。

EnglishQuestion: What major complications can occur after acute myocardial infarction?
JapaneseQuestion: 急性心筋梗塞後に起こり得る主な合併症は？
EnglishAnswer: Atrial fibrillation, heart block, VT or VF, right ventricular infarction, tamponade, heart failure or cardiogenic shock, acute mitral regurgitation, ventricular septal defect, thrombus, aneurysm, and left ventricular remodeling.
JapaneseAnswer: 心房細動、房室ブロック、心室頻拍・細動、右室梗塞、心タンポナーデ、心不全・心原性ショック、急性僧帽弁逆流、心室中隔欠損、血栓、心室瘤、左室リモデリング。

EnglishQuestion: Where do most pulmonary emboli originate?
JapaneseQuestion: 肺塞栓の多くはどこに由来するか？
EnglishAnswer: Deep vein thrombosis in the lower limbs or pelvis.
JapaneseAnswer: 下肢または骨盤の深部静脈血栓症。

EnglishQuestion: What are the three components of Virchow's triad?
JapaneseQuestion: Virchowの三徴は？
EnglishAnswer: Endothelial injury, venous stasis, and hypercoagulability.
JapaneseAnswer: 内皮障害、静脈うっ滞、過凝固。

EnglishQuestion: Name major risk factors for deep vein thrombosis and pulmonary embolism.
JapaneseQuestion: 深部静脈血栓症・肺塞栓症の主な危険因子は？
EnglishAnswer: Prolonged immobilization, surgery, severe trauma, burns or fractures, hypercoagulability, oral contraceptives, and congestive heart failure.
JapaneseAnswer: 長期臥床、手術、重症外傷、熱傷・骨折、過凝固、経口避妊薬、うっ血性心不全。

EnglishQuestion: What is the pathophysiologic flow from deep vein thrombosis to shock in pulmonary embolism?
JapaneseQuestion: 深部静脈血栓症から肺塞栓性ショックに至る病態の流れは？
EnglishAnswer: DVT -> embolization through the inferior vena cava -> pulmonary artery obstruction -> increased pulmonary artery pressure -> right ventricular pressure overload -> reduced cardiac output -> hypotension and tachycardia.
JapaneseAnswer: DVT→下大静脈経由で塞栓→肺動脈閉塞→肺動脈圧上昇→右室圧負荷→心拍出量低下→低血圧・頻脈。

EnglishQuestion: How does pulmonary embolism cause hypoxemia?
JapaneseQuestion: 肺塞栓症はどのように低酸素血症を起こすか？
EnglishAnswer: Pulmonary artery obstruction creates ventilation-perfusion mismatch.
JapaneseAnswer: 肺動脈閉塞によって換気血流比不均衡が生じる。

EnglishQuestion: Why are small pulmonary emboli often asymptomatic and self-limited?
JapaneseQuestion: 小さな肺塞栓が無症候で自然消失しやすいのはなぜか？
EnglishAnswer: The lungs have a dual blood supply.
JapaneseAnswer: 肺には二重血流があるため。

EnglishQuestion: In which patients is pulmonary infarction more likely, and approximately how often does it occur in PE?
JapaneseQuestion: 肺梗塞はどの患者で起こりやすく、PEの約何％に生じるか？
EnglishAnswer: It is more likely with medium-to-large vessel occlusion in patients with poor cardiopulmonary reserve and occurs in approximately 10% of PE.
JapaneseAnswer: 心肺予備能が低い患者の中〜大血管閉塞で起こりやすく、PEの約10%に生じる。

EnglishQuestion: What symptoms are typical of pulmonary embolism?
JapaneseQuestion: 肺塞栓症の典型症状は？
EnglishAnswer: Dyspnea, tachypnea, pleuritic chest pain, cough, and hemoptysis.
JapaneseAnswer: 呼吸困難、頻呼吸、胸膜性胸痛、咳、喀血。

EnglishQuestion: What findings indicate severe pulmonary embolism?
JapaneseQuestion: 重症肺塞栓症を示す所見は？
EnglishAnswer: Hypotension, cyanosis, syncope, or cardiac arrest.
JapaneseAnswer: 低血圧、チアノーゼ、失神、心停止。

EnglishQuestion: How is hemodynamic instability defined in pulmonary embolism?
JapaneseQuestion: 肺塞栓症における血行動態不安定はどう定義するか？
EnglishAnswer: Systolic blood pressure <90 mmHg for more than 15 minutes, shock, or a marked blood-pressure fall lasting more than 15 minutes.
JapaneseAnswer: 収縮期血圧90 mmHg未満が15分超持続、ショック、または著明な血圧低下が15分超持続。

EnglishQuestion: What is the most common ECG finding in pulmonary embolism?
JapaneseQuestion: 肺塞栓症で最も多い心電図所見は？
EnglishAnswer: Sinus tachycardia.
JapaneseAnswer: 洞性頻脈。

EnglishQuestion: How common is the classic S1Q3T3 ECG pattern in pulmonary embolism?
JapaneseQuestion: 肺塞栓症で典型的なS1Q3T3心電図パターンはどの程度みられるか？
EnglishAnswer: In fewer than 20% of cases.
JapaneseAnswer: 20%未満。

EnglishQuestion: What Wells score values define low, intermediate, and high PE probability?
JapaneseQuestion: WellsスコアでPEの低・中・高確率を示す値は？
EnglishAnswer: Low: <2; intermediate: 2-6; high: >6.
JapaneseAnswer: 低確率：2未満、中確率：2〜6、高確率：6超。

EnglishQuestion: What Wells score values define PE unlikely and PE likely in the two-level model?
JapaneseQuestion: Wellsスコアの2段階モデルでPE unlikelyとPE likelyを示す値は？
EnglishAnswer: PE unlikely: <=4; PE likely: >4.
JapaneseAnswer: PE unlikely：4以下、PE likely：4超。

EnglishQuestion: How should D-dimer be used in suspected pulmonary embolism?
JapaneseQuestion: 肺塞栓症疑いでDダイマーをどう用いるか？
EnglishAnswer: Use it to exclude PE in low-probability or PE-unlikely patients; a positive result leads to imaging but does not confirm PE.
JapaneseAnswer: 低確率またはPE unlikely患者で除外に用い、陽性なら画像検査へ進むがPE確定とはならない。

EnglishQuestion: What age-adjusted D-dimer cutoff can be used in appropriate patients older than 50 years?
JapaneseQuestion: 50歳を超える適切な患者で用い得る年齢調整Dダイマーカットオフは？
EnglishAnswer: Age x 10 ng/mL FEU.
JapaneseAnswer: 年齢×10 ng/mL FEU。

EnglishQuestion: What imaging tests are used to diagnose pulmonary embolism?
JapaneseQuestion: 肺塞栓症の診断に用いる画像検査は？
EnglishAnswer: CT pulmonary angiography, ventilation-perfusion scanning, and lower-extremity venous ultrasonography.
JapaneseAnswer: CT肺動脈造影、換気血流シンチグラフィ、下肢静脈超音波検査。

EnglishQuestion: How do the Wells score and simplified PESI differ?
JapaneseQuestion: Wellsスコアと簡略PESIはどう異なるか？
EnglishAnswer: Wells estimates the pretest probability that PE is present; simplified PESI estimates early prognosis after PE is diagnosed.
JapaneseAnswer: WellsはPEが存在する診断前確率を推定し、簡略PESIはPE診断後の早期予後を評価する。

EnglishQuestion: Which variables score one point each in simplified PESI?
JapaneseQuestion: 簡略PESIで各1点となる項目は？
EnglishAnswer: Age >80 years, cancer, chronic cardiopulmonary disease, heart rate >=110/min, systolic blood pressure <100 mmHg, and oxygen saturation <90%.
JapaneseAnswer: 80歳超、悪性腫瘍、慢性心肺疾患、心拍数110/分以上、収縮期血圧100 mmHg未満、酸素飽和度90%未満。

EnglishQuestion: What is the basic treatment and minimum usual duration for pulmonary embolism?
JapaneseQuestion: 肺塞栓症の基本治療と通常の最低治療期間は？
EnglishAnswer: Anticoagulation for at least 3 months, with extension based on provoking factors and recurrence and bleeding risks.
JapaneseAnswer: 少なくとも3か月の抗凝固療法を行い、誘因と再発・出血リスクに基づいて延長を判断する。

EnglishQuestion: When is thrombolytic therapy mainly indicated in pulmonary embolism?
JapaneseQuestion: 肺塞栓症で血栓溶解療法が主に適応となるのはいつか？
EnglishAnswer: In hemodynamically unstable high-risk PE after contraindications are assessed.
JapaneseAnswer: 禁忌を評価したうえでの血行動態不安定な高リスクPE。

EnglishQuestion: When should an inferior vena cava filter be considered in pulmonary embolism?
JapaneseQuestion: 肺塞栓症で下大静脈フィルターをいつ検討するか？
EnglishAnswer: When anticoagulation is absolutely contraindicated or PE recurs despite appropriate anticoagulation.
JapaneseAnswer: 抗凝固が絶対禁忌、または適切な抗凝固中にもPEが再発した場合。

EnglishQuestion: What three mechanisms produce bradyarrhythmias?
JapaneseQuestion: 徐脈性不整脈を生じる3つの機序は？
EnglishAnswer: Reduced automaticity, conduction block, and escape rhythms.
JapaneseAnswer: 自動能低下、伝導ブロック、補充調律。

EnglishQuestion: How are bradycardia and relative bradycardia defined?
JapaneseQuestion: 徐脈と相対的徐脈はどう定義するか？
EnglishAnswer: Bradycardia is a heart rate <60/min; relative bradycardia is a rate of 60/min or higher that is inappropriately low for the clinical condition.
JapaneseAnswer: 徐脈は心拍数60/分未満、相対的徐脈は60/分以上でも病態に対して不適切に低い状態。

EnglishQuestion: What are major cardiac causes of bradyarrhythmia?
JapaneseQuestion: 徐脈性不整脈の主な心臓性原因は？
EnglishAnswer: Acute or chronic ischemic heart disease, coronary artery disease, valvular disease, degenerative conduction disease, and sick sinus syndrome.
JapaneseAnswer: 急性・慢性虚血性心疾患、冠動脈疾患、弁膜症、変性伝導疾患、洞不全症候群。

EnglishQuestion: What are major extracardiac causes of bradyarrhythmia?
JapaneseQuestion: 徐脈性不整脈の主な心外性原因は？
EnglishAnswer: Hypothyroidism, electrolyte abnormalities, autoimmune disease, beta-blockers, digoxin, and drug abuse.
JapaneseAnswer: 甲状腺機能低下症、電解質異常、自己免疫疾患、β遮断薬、ジゴキシン、薬物乱用。

EnglishQuestion: What is the ECG definition of first-degree AV block?
JapaneseQuestion: 第1度房室ブロックの心電図定義は？
EnglishAnswer: Prolonged PR interval with conduction of every atrial impulse.
JapaneseAnswer: PR間隔延長があるが、すべての心房刺激が伝導する。

EnglishQuestion: What is the ECG pattern of Mobitz I AV block?
JapaneseQuestion: Mobitz I型房室ブロックの心電図パターンは？
EnglishAnswer: Progressive PR prolongation followed by a dropped QRS complex.
JapaneseAnswer: PR間隔が徐々に延長した後にQRSが脱落する。

EnglishQuestion: What is the ECG pattern of Mobitz II AV block?
JapaneseQuestion: Mobitz II型房室ブロックの心電図パターンは？
EnglishAnswer: Sudden dropped QRS complexes with a constant PR interval in conducted beats.
JapaneseAnswer: 伝導する拍のPR間隔は一定のまま、突然QRSが脱落する。

EnglishQuestion: How do Mobitz I and Mobitz II AV block differ on ECG?
JapaneseQuestion: Mobitz I型とII型房室ブロックは心電図でどう異なるか？
EnglishAnswer: Mobitz I shows progressive PR prolongation before a dropped beat; Mobitz II shows a constant PR interval with sudden dropped beats.
JapaneseAnswer: I型はQRS脱落前にPRが漸次延長し、II型はPR一定のまま突然QRSが脱落する。

EnglishQuestion: What is complete third-degree AV block?
JapaneseQuestion: 完全第3度房室ブロックとは？
EnglishAnswer: Complete atrioventricular dissociation in which atria and ventricles beat independently and the ventricles depend on an escape rhythm.
JapaneseAnswer: 心房と心室が独立して興奮する完全房室解離で、心室は補充調律に依存する。

EnglishQuestion: How do junctional and infranodal escape rhythms differ in complete AV block?
JapaneseQuestion: 完全房室ブロックで接合部性とHis束下性の補充調律はどう異なるか？
EnglishAnswer: A junctional escape is relatively faster with a narrower QRS; an infranodal escape is slower, wider, and less stable.
JapaneseAnswer: 接合部性補充調律は比較的速くQRSが狭いが、His束下性は遅くQRSが広く不安定。

EnglishQuestion: What ECG event characterizes sinoatrial exit block?
JapaneseQuestion: 洞房出口ブロックを特徴づける心電図イベントは？
EnglishAnswer: Loss of an expected entire P-QRS-T complex in relation to the sinus cycle.
JapaneseAnswer: 洞周期に対して予定されたP-QRS-T全体が脱落する。

EnglishQuestion: Which ECG features localize AV block versus intraventricular block?
JapaneseQuestion: 房室ブロックと心室内ブロックの局在に用いる心電図所見は？
EnglishAnswer: AV block is assessed from the P-QRS relationship, PR interval, and dropped QRS complexes; intraventricular block is assessed from QRS width and morphology.
JapaneseAnswer: 房室ブロックはP-QRS関係、PR間隔、QRS脱落で、心室内ブロックはQRS幅と形態で評価する。

EnglishQuestion: What rhythm patterns occur in sick sinus syndrome?
JapaneseQuestion: 洞不全症候群でみられる調律パターンは？
EnglishAnswer: Tachy-brady variation, sinus arrest, and dropped P waves from sinoatrial block.
JapaneseAnswer: 頻脈徐脈変動、洞停止、洞房ブロックによるP波脱落。

EnglishQuestion: What symptoms can bradyarrhythmias cause?
JapaneseQuestion: 徐脈性不整脈はどのような症状を起こし得るか？
EnglishAnswer: Dizziness, syncope, dyspnea, fatigue, palpitations, angina, and cardiac arrest.
JapaneseAnswer: めまい、失神、呼吸困難、倦怠感、動悸、狭心症、心停止。

EnglishQuestion: Which findings indicate cardiopulmonary compromise from bradycardia?
JapaneseQuestion: 徐脈による心肺機能障害を示す所見は？
EnglishAnswer: Hypotension, shock, altered mental status, myocardial ischemia, or acute heart failure.
JapaneseAnswer: 低血圧、ショック、意識変容、心筋虚血、急性心不全。

EnglishQuestion: What is the acute treatment flow for symptomatic bradycardia with cardiopulmonary compromise?
JapaneseQuestion: 心肺機能障害を伴う症候性徐脈の急性治療の流れは？
EnglishAnswer: Correct reversible causes -> give atropine according to the local protocol -> if ineffective, use transcutaneous pacing -> consider dopamine or epinephrine infusion and expert consultation -> use transvenous pacing when needed.
JapaneseAnswer: 可逆的原因を補正→地域プロトコルに従いアトロピン→無効なら経皮ペーシング→ドパミンまたはエピネフリン持続投与と専門家相談→必要時経静脈ペーシング。

EnglishQuestion: What atropine regimen is specified in the 2025 AHA bradycardia algorithm?
JapaneseQuestion: 2025年AHA徐脈アルゴリズムのアトロピン投与法は？
EnglishAnswer: 1 mg intravenously every 3-5 minutes to a maximum of 3 mg.
JapaneseAnswer: 1 mgを3〜5分ごとに静注し、最大3 mg。

EnglishQuestion: What atropine regimen is specified in the 2025 ERC/RCUK bradycardia algorithm?
JapaneseQuestion: 2025年ERC/RCUK徐脈アルゴリズムのアトロピン投与法は？
EnglishAnswer: 500 micrograms intravenously every 3-5 minutes to a maximum of 3 mg.
JapaneseAnswer: 500マイクログラムを3〜5分ごとに静注し、最大3 mg。

EnglishQuestion: In which AV blocks is atropine often ineffective?
JapaneseQuestion: アトロピンが効きにくい房室ブロックは？
EnglishAnswer: Mobitz II, high-degree, and complete AV block, especially with a wide-QRS escape rhythm.
JapaneseAnswer: Mobitz II型、高度、完全房室ブロック、特に幅広いQRSの補充調律。

EnglishQuestion: Where do supraventricular arrhythmias originate, and what are their two main mechanisms?
JapaneseQuestion: 上室性不整脈はどこに由来し、主な2つの機序は？
EnglishAnswer: They originate in the atria or AV node and result from focal activity or reentry.
JapaneseAnswer: 心房または房室結節に由来し、局所性活動またはリエントリーで生じる。

EnglishQuestion: What mechanisms produce focal supraventricular arrhythmias?
JapaneseQuestion: 局所性上室性不整脈を生じる機序は？
EnglishAnswer: Abnormal automaticity and triggered activity.
JapaneseAnswer: 異常自動能と撃発活動。

EnglishQuestion: What conditions are required for a reentry circuit?
JapaneseQuestion: リエントリー回路の成立に必要な条件は？
EnglishAnswer: Two pathways with different conduction velocities and refractory periods, plus unidirectional block.
JapaneseAnswer: 伝導速度と不応期が異なる2経路、および一方向性ブロック。

EnglishQuestion: What are common symptoms and hemodynamic effects of supraventricular tachycardia at 140-250/min?
JapaneseQuestion: 心拍数140〜250/分の上室性頻拍で一般的な症状と血行動態への影響は？
EnglishAnswer: Palpitations, dizziness, syncope, dyspnea, anxiety, chest pain, reduced cardiac output, and hypotension.
JapaneseAnswer: 動悸、めまい、失神、呼吸困難、不安、胸痛、心拍出量低下、低血圧。

EnglishQuestion: What ECG features characterize atrial flutter?
JapaneseQuestion: 心房粗動を特徴づける心電図所見は？
EnglishAnswer: An atrial rate of 250-350/min with saw-tooth F waves in the inferior leads.
JapaneseAnswer: 心房拍数250〜350/分と下壁誘導の鋸歯状F波。

EnglishQuestion: What ECG features characterize atrial fibrillation?
JapaneseQuestion: 心房細動を特徴づける心電図所見は？
EnglishAnswer: Atrial activity at 300-600/min, absent P waves, and an irregular rhythm.
JapaneseAnswer: 心房活動300〜600/分、P波消失、不規則な調律。

EnglishQuestion: What ECG features characterize AV nodal reentrant tachycardia (AVNRT)?
JapaneseQuestion: 房室結節リエントリー性頻拍（AVNRT）を特徴づける心電図所見は？
EnglishAnswer: A regular tachycardia at 140-240/min in which the retrograde P wave is often hidden within or immediately after the QRS complex.
JapaneseAnswer: 140〜240/分の規則的頻拍で、逆行性P波がQRS内または直後に隠れることが多い。

EnglishQuestion: What conduction sequence occurs in typical slow-fast AVNRT?
JapaneseQuestion: 典型的なslow-fast型AVNRTの伝導順序は？
EnglishAnswer: Antegrade conduction through the AV nodal slow pathway and retrograde conduction through the fast pathway.
JapaneseAnswer: 房室結節内slow pathwayを順行し、fast pathwayを逆行する。

EnglishQuestion: What baseline ECG findings suggest Wolff-Parkinson-White pre-excitation?
JapaneseQuestion: Wolff-Parkinson-White型早期興奮を示唆する基礎心電図所見は？
EnglishAnswer: A short PR interval and a delta wave.
JapaneseAnswer: PR短縮とデルタ波。

EnglishQuestion: How do orthodromic and antidromic AV reentrant tachycardia differ?
JapaneseQuestion: 正方向性と逆方向性房室リエントリー性頻拍はどう異なるか？
EnglishAnswer: Orthodromic AVRT conducts antegrade through the AV node and retrograde through the accessory pathway, producing a narrow QRS; antidromic AVRT conducts antegrade through the accessory pathway and retrograde through the AV node, producing a wide pre-excited QRS.
JapaneseAnswer: 正方向性AVRTは房室結節を順行し副伝導路を逆行して狭いQRSとなり、逆方向性AVRTは副伝導路を順行し房室結節を逆行して幅広い早期興奮QRSとなる。

EnglishQuestion: Which supraventricular tachycardias require the AV node as part of their circuit?
JapaneseQuestion: 房室結節を回路の必須部分とする上室性頻拍は？
EnglishAnswer: AVNRT and AVRT.
JapaneseAnswer: AVNRTとAVRT。

EnglishQuestion: Which supraventricular arrhythmias do not require the AV node as part of their circuit?
JapaneseQuestion: 房室結節を回路の必須部分としない上室性不整脈は？
EnglishAnswer: Atrial tachycardia, atrial flutter, and atrial fibrillation.
JapaneseAnswer: 心房頻拍、心房粗動、心房細動。

EnglishQuestion: How does adenosine affect AVNRT and orthodromic AVRT?
JapaneseQuestion: アデノシンはAVNRTと正方向性AVRTにどう作用するか？
EnglishAnswer: It can terminate them by transiently blocking AV nodal conduction.
JapaneseAnswer: 房室結節伝導を一過性に遮断して停止させ得る。

EnglishQuestion: How does adenosine affect atrial tachycardia, atrial flutter, and atrial fibrillation?
JapaneseQuestion: アデノシンは心房頻拍、心房粗動、心房細動にどう作用するか？
EnglishAnswer: It transiently blocks AV conduction and may reveal atrial activity, but usually does not terminate the atrial mechanism itself.
JapaneseAnswer: 房室伝導を一過性に遮断して心房活動を見やすくするが、通常は心房内機序自体を停止させない。

EnglishQuestion: What drugs should be avoided in irregular wide-complex tachycardia when pre-excited atrial fibrillation is suspected?
JapaneseQuestion: 早期興奮性心房細動が疑われる不規則幅広QRS頻拍で避けるべき薬剤は？
EnglishAnswer: AV nodal blockers.
JapaneseAnswer: 房室結節遮断薬。

EnglishQuestion: What are red flags in the diagnostic evaluation of palpitations?
JapaneseQuestion: 動悸の診断評価におけるレッドフラッグは？
EnglishAnswer: Pre-excitation, structural heart disease, and syncope.
JapaneseAnswer: 早期興奮、構造的心疾患、失神。

EnglishQuestion: How should ambulatory ECG monitoring be selected for palpitations?
JapaneseQuestion: 動悸に対する携帯型心電図モニタリングはどう選択するか？
EnglishAnswer: Choose a Holter, patch, or event monitor according to attack frequency, aiming to record the ECG during symptoms.
JapaneseAnswer: 発作頻度に応じてホルター、パッチ、イベントモニターを選び、症状時心電図の記録を目指す。

EnglishQuestion: What is the acute treatment sequence for stable regular narrow-complex tachycardia?
JapaneseQuestion: 安定した規則的狭いQRS頻拍の急性治療の流れは？
EnglishAnswer: Vagal maneuver -> intravenous adenosine -> if appropriate, a non-dihydropyridine calcium channel blocker or beta-blocker.
JapaneseAnswer: 迷走神経刺激手技→アデノシン静注→適応を確認して非ジヒドロピリジン系Ca拮抗薬またはβ遮断薬。

EnglishQuestion: What is the acute treatment for hemodynamically unstable regular narrow-complex tachycardia?
JapaneseQuestion: 血行動態不安定な規則的狭いQRS頻拍の急性治療は？
EnglishAnswer: Urgent synchronized cardioversion.
JapaneseAnswer: 緊急同期下カルディオバージョン。

EnglishQuestion: What therapies are used for atrial flutter?
JapaneseQuestion: 心房粗動に用いる治療は？
EnglishAnswer: Anticoagulation, rate control, and rhythm control with electrical cardioversion or ablation.
JapaneseAnswer: 抗凝固、心拍数調節、電気的カルディオバージョンまたはアブレーションによる調律管理。

EnglishQuestion: Which ablation target can provide definitive treatment for AVNRT?
JapaneseQuestion: AVNRTを根治し得るアブレーション標的は？
EnglishAnswer: The AV nodal slow pathway.
JapaneseAnswer: 房室結節slow pathway。

EnglishQuestion: What are the two major clinical consequences of atrial fibrillation (AF)?
JapaneseQuestion: 心房細動（AF）の二大臨床的帰結は？
EnglishAnswer: Thromboembolism from ineffective atrial contraction and circulatory impairment from an irregular ventricular response.
JapaneseAnswer: 無効な心房収縮による血栓塞栓と、不規則な心室応答による循環障害。

EnglishQuestion: What is the typical atrial activation rate in atrial fibrillation?
JapaneseQuestion: 心房細動の典型的な心房興奮頻度は？
EnglishAnswer: 300-600/min.
JapaneseAnswer: 300〜600/分。

EnglishQuestion: What ECG findings define atrial fibrillation?
JapaneseQuestion: 心房細動を定義する心電図所見は？
EnglishAnswer: Absence of consistent P waves with irregular RR intervals.
JapaneseAnswer: 一貫したP波の消失と不規則なRR間隔。

EnglishQuestion: What cardiovascular risk factors predispose to atrial fibrillation?
JapaneseQuestion: 心房細動の素因となる心血管危険因子は？
EnglishAnswer: Advanced age, hypertension, diabetes, smoking, obesity, and sleep apnea.
JapaneseAnswer: 高齢、高血圧、糖尿病、喫煙、肥満、睡眠時無呼吸。

EnglishQuestion: What cardiac diseases predispose to atrial fibrillation?
JapaneseQuestion: 心房細動の素因となる心疾患は？
EnglishAnswer: Coronary artery disease, valvular disease, heart failure, pericarditis, and cardiomyopathy.
JapaneseAnswer: 冠動脈疾患、弁膜症、心不全、心膜炎、心筋症。

EnglishQuestion: What noncardiac conditions can precipitate atrial fibrillation?
JapaneseQuestion: 心房細動を誘発し得る心外性病態は？
EnglishAnswer: COPD, pulmonary embolism, pneumonia, hyperthyroidism, and drugs such as adenosine or digoxin.
JapaneseAnswer: COPD、肺塞栓症、肺炎、甲状腺機能亢進症、アデノシンやジゴキシンなどの薬剤。

EnglishQuestion: How does atrial fibrillation promote thromboembolism?
JapaneseQuestion: 心房細動はどのように血栓塞栓を促進するか？
EnglishAnswer: Rapid uncoordinated atrial activity abolishes effective atrial contraction, causing blood stasis and thrombus formation.
JapaneseAnswer: 急速で無秩序な心房活動により有効な心房収縮が消失し、血液うっ滞と血栓形成を生じる。

EnglishQuestion: Why does atrial fibrillation tend to become self-perpetuating?
JapaneseQuestion: 心房細動が自己持続しやすくなるのはなぜか？
EnglishAnswer: AF promotes electrical and structural atrial remodeling, which in turn facilitates further AF.
JapaneseAnswer: AFが電気的・構造的心房リモデリングを促進し、それがさらにAFを起こしやすくするため。

EnglishQuestion: How are paroxysmal and persistent atrial fibrillation distinguished?
JapaneseQuestion: 発作性と持続性心房細動はどう区別するか？
EnglishAnswer: Paroxysmal AF terminates spontaneously or with intervention within 7 days; persistent AF lasts longer than 7 days.
JapaneseAnswer: 発作性AFは自然または介入により7日以内に停止し、持続性AFは7日を超えて持続する。

EnglishQuestion: What is long-standing persistent atrial fibrillation?
JapaneseQuestion: 長期持続性心房細動とは？
EnglishAnswer: AF that has persisted for more than 1 year.
JapaneseAnswer: 1年を超えて持続するAF。

EnglishQuestion: What defines permanent atrial fibrillation?
JapaneseQuestion: 永続性心房細動を定義するものは？
EnglishAnswer: A shared decision by the patient and clinician to stop pursuing restoration of sinus rhythm.
JapaneseAnswer: 洞調律回復をこれ以上目指さないと患者と医療者が共同決定した状態。

EnglishQuestion: Which tests are included in the basic evaluation of atrial fibrillation?
JapaneseQuestion: 心房細動の基本評価に含む検査は？
EnglishAnswer: ECG, chest radiography, potassium and renal function, selected drug levels, and transthoracic echocardiography to assess ventricular function, valves, pericardial effusion, and left atrial size.
JapaneseAnswer: 心電図、胸部X線、K・腎機能、必要な薬物濃度、心室機能・弁・心嚢液・左房径を評価する経胸壁心エコー。

EnglishQuestion: Which imaging test is used to exclude left atrial appendage thrombus before cardioversion?
JapaneseQuestion: カルディオバージョン前に左心耳血栓を除外する画像検査は？
EnglishAnswer: Transesophageal echocardiography (TEE).
JapaneseAnswer: 経食道心エコー（TEE）。

EnglishQuestion: What are the four pillars of atrial fibrillation management?
JapaneseQuestion: 心房細動管理の4本柱は？
EnglishAnswer: Correction of underlying disease and lifestyle factors, stroke prevention, rate control, and rhythm control.
JapaneseAnswer: 基礎疾患・生活習慣の是正、脳卒中予防、心拍数調節、調律管理。

EnglishQuestion: What is the preferred immediate treatment for atrial fibrillation causing hypotension, shock, ischemia, or pulmonary edema?
JapaneseQuestion: 低血圧、ショック、虚血、肺水腫を起こす心房細動の優先治療は？
EnglishAnswer: Urgent synchronized cardioversion.
JapaneseAnswer: 緊急同期下カルディオバージョン。

EnglishQuestion: Which drugs are commonly used for rate control in stable atrial fibrillation?
JapaneseQuestion: 安定した心房細動の心拍数調節に一般的に用いる薬剤は？
EnglishAnswer: A beta-blocker or a non-dihydropyridine calcium channel blocker, selected according to cardiac function; digoxin may be an option.
JapaneseAnswer: 心機能に応じてβ遮断薬または非ジヒドロピリジン系Ca拮抗薬を選び、ジゴキシンも選択肢となる。

EnglishQuestion: Which rate-control drug should be avoided in HFrEF?
JapaneseQuestion: HFrEFで避けるべき心拍数調節薬は？
EnglishAnswer: Verapamil.
JapaneseAnswer: ベラパミル。

EnglishQuestion: Which rhythm-control drugs should be avoided after prior myocardial infarction, in significant structural heart disease, or in HFrEF?
JapaneseQuestion: 心筋梗塞既往、重大な構造的心疾患、HFrEFで避けるべき調律管理薬は？
EnglishAnswer: Flecainide and propafenone.
JapaneseAnswer: フレカイニドとプロパフェノン。

EnglishQuestion: What are the components and maximum score of CHA2DS2-VASc?
JapaneseQuestion: CHA2DS2-VAScの構成項目と最高点は？
EnglishAnswer: Heart failure or LV dysfunction 1, hypertension 1, age >=75 years 2, diabetes 1, prior stroke/TIA/systemic embolism 2, vascular disease 1, age 65-74 years 1, and female sex 1; maximum 9, with age counted only once.
JapaneseAnswer: 心不全・左室機能障害1、高血圧1、75歳以上2、糖尿病1、脳卒中・TIA・全身性塞栓既往2、血管疾患1、65〜74歳1、女性1で、年齢は重複加点せず最高9点。

EnglishQuestion: How should female sex be interpreted in CHA2DS2-VASc?
JapaneseQuestion: CHA2DS2-VAScで女性という項目をどう解釈するか？
EnglishAnswer: It is a risk modifier rather than an independent indication; female sex alone should not trigger anticoagulation.
JapaneseAnswer: 独立した適応というよりリスク修飾因子であり、女性1点だけで抗凝固を開始しない。

EnglishQuestion: What is the key difference between electrical and pharmacological cardioversion?
JapaneseQuestion: 電気的カルディオバージョンと薬理学的カルディオバージョンの主な違いは？
EnglishAnswer: Electrical cardioversion uses an R-wave-synchronized shock; pharmacological cardioversion uses an antiarrhythmic drug to restore sinus rhythm.
JapaneseAnswer: 電気的カルディオバージョンはR波同期ショックを用い、薬理学的カルディオバージョンは抗不整脈薬で洞調律を回復する。

EnglishQuestion: Where are the pads placed in the anterolateral cardioversion position?
JapaneseQuestion: 前外側カルディオバージョンでパッドをどこに置くか？
EnglishAnswer: One pad below the right clavicle at the right sternal border and the other on the left lateral chest near the apex.
JapaneseAnswer: 一方を右鎖骨下の胸骨右縁、他方を左側胸部の心尖部付近に置く。

EnglishQuestion: Which sites should be avoided when placing cardioversion pads?
JapaneseQuestion: カルディオバージョン用パッドの貼付で避ける部位は？
EnglishAnswer: Breast tissue, directly over an implanted device, and over a medication patch.
JapaneseAnswer: 乳房、植込みデバイス直上、薬剤パッチ上。

EnglishQuestion: Why is electrical cardioversion synchronized to the R wave?
JapaneseQuestion: 電気的カルディオバージョンをR波に同期するのはなぜか？
EnglishAnswer: To avoid delivering a shock during the vulnerable repolarization period and inducing ventricular fibrillation.
JapaneseAnswer: 再分極の受攻期への通電による心室細動誘発を避けるため。

EnglishQuestion: What must be verified on the monitor immediately before synchronized cardioversion?
JapaneseQuestion: 同期下カルディオバージョン直前にモニターで何を確認するか？
EnglishAnswer: A synchronization marker on every QRS complex.
JapaneseAnswer: 各QRSに同期マーカーが付いていること。

EnglishQuestion: Why must synchronization mode be rechecked after each shock?
JapaneseQuestion: 各ショック後に同期モードを再確認するのはなぜか？
EnglishAnswer: Some defibrillators automatically disable synchronization after a shock.
JapaneseAnswer: 機種によっては通電後に同期モードが自動解除されるため。

EnglishQuestion: What safety checks are required immediately before delivering a cardioversion shock?
JapaneseQuestion: カルディオバージョン通電直前に必要な安全確認は？
EnglishAnswer: Move oxygen away from the chest and confirm verbally and visually that everyone is clear of the patient and bed.
JapaneseAnswer: 酸素源を胸壁から離し、全員が患者とベッドから離れたことを声と目で確認する。

EnglishQuestion: Which tachyarrhythmias with a pulse and serious signs are treated with synchronized cardioversion?
JapaneseQuestion: 脈があり重篤徴候を伴う場合、同期下カルディオバージョンを行う頻脈性不整脈は？
EnglishAnswer: Atrial fibrillation, atrial flutter, regular narrow-complex tachycardia, and monomorphic ventricular tachycardia.
JapaneseAnswer: 心房細動、心房粗動、規則的狭いQRS頻拍、単形性心室頻拍。

EnglishQuestion: Which ventricular rhythms require unsynchronized shock rather than synchronized cardioversion?
JapaneseQuestion: 同期下カルディオバージョンではなく非同期ショックを要する心室調律は？
EnglishAnswer: Polymorphic ventricular tachycardia and pulseless VT or ventricular fibrillation.
JapaneseAnswer: 多形性心室頻拍と、無脈性心室頻拍または心室細動。

EnglishQuestion: What is the treatment flow for a tachyarrhythmia according to pulse and serious signs?
JapaneseQuestion: 脈と重篤徴候に基づく頻脈性不整脈の治療の流れは？
EnglishAnswer: No pulse: CPR and unsynchronized defibrillation -> pulse present: assess serious signs -> serious signs with a synchronizable rhythm: synchronized cardioversion -> polymorphic VT: unsynchronized high-energy shock.
JapaneseAnswer: 無脈：CPRと非同期除細動→脈あり：重篤徴候を評価→同期可能な調律で重篤徴候あり：同期下カルディオバージョン→多形性VT：非同期高エネルギーショック。

EnglishQuestion: Should elective-preparation steps delay cardioversion in hemodynamic instability?
JapaneseQuestion: 血行動態不安定時に待機的準備のためカルディオバージョンを遅らせるべきか？
EnglishAnswer: No. Shock, ischemia, altered consciousness, or acute heart failure requires urgent cardioversion.
JapaneseAnswer: 遅らせない。ショック、虚血、意識障害、急性心不全では緊急カルディオバージョンを行う。

EnglishQuestion: What should be checked before elective electrical cardioversion?
JapaneseQuestion: 待機的電気的カルディオバージョン前に確認すべきことは？
EnglishAnswer: Fasting, thyroid status, IV access and sedation, left atrial appendage thrombus, digoxin toxicity, electrolyte abnormalities, fever, and metabolic abnormalities.
JapaneseAnswer: 絶食、甲状腺機能、静脈路と鎮静、左心耳血栓、ジゴキシン中毒、電解質異常、発熱、代謝異常。

EnglishQuestion: What are major complications of electrical cardioversion?
JapaneseQuestion: 電気的カルディオバージョンの主な合併症は？
EnglishAnswer: Asystole, bradycardia, ventricular fibrillation, thromboembolism, hypotension, and skin burns.
JapaneseAnswer: 心静止、徐脈、心室細動、血栓塞栓、低血圧、皮膚熱傷。

EnglishQuestion: Which drugs may be selected for pharmacological cardioversion of atrial fibrillation?
JapaneseQuestion: 心房細動の薬理学的カルディオバージョンに選択し得る薬剤は？
EnglishAnswer: Amiodarone, flecainide, or propafenone, selected according to the patient's cardiac substrate.
JapaneseAnswer: 患者の心疾患背景に応じてアミオダロン、フレカイニド、プロパフェノンを選択する。

EnglishQuestion: Which antiarrhythmic drugs are mainly used for rate control rather than conversion of atrial fibrillation?
JapaneseQuestion: 心房細動の洞調律化より主に心拍数調節に用いる抗不整脈薬は？
EnglishAnswer: Beta-blockers, verapamil, and digoxin.
JapaneseAnswer: β遮断薬、ベラパミル、ジゴキシン。

EnglishQuestion: What are the main uses of lidocaine and adenosine in arrhythmia treatment?
JapaneseQuestion: 不整脈治療におけるリドカインとアデノシンの主な用途は？
EnglishAnswer: Lidocaine is mainly used for ventricular arrhythmias; adenosine is used to terminate or diagnose AV-node-dependent supraventricular tachycardia.
JapaneseAnswer: リドカインは主に心室性不整脈、アデノシンは房室結節依存性上室頻拍の停止・診断に用いる。

EnglishQuestion: In which patients should flecainide and propafenone be avoided?
JapaneseQuestion: フレカイニドとプロパフェノンを避けるべき患者は？
EnglishAnswer: Patients with prior myocardial infarction, significant structural heart disease, or HFrEF.
JapaneseAnswer: 心筋梗塞既往、重大な構造的心疾患、HFrEFがある患者。

EnglishQuestion: What anticoagulation strategy is used before elective cardioversion when AF or flutter has lasted more than 48 hours or onset is unknown?
JapaneseQuestion: AF・粗動が48時間超持続または発症時刻不明の場合、待機的カルディオバージョン前にどの抗凝固戦略を用いるか？
EnglishAnswer: At least 3 weeks of effective anticoagulation or a TEE-guided strategy that excludes left atrial thrombus.
JapaneseAnswer: 少なくとも3週間の有効な抗凝固、またはTEEで左房血栓を除外する戦略。

EnglishQuestion: How long should anticoagulation continue after cardioversion of AF or flutter lasting more than 48 hours or of unknown duration?
JapaneseQuestion: 48時間超または持続時間不明のAF・粗動をカルディオバージョンした後、抗凝固をどのくらい続けるか？
EnglishAnswer: For at least 4 weeks; longer treatment depends on thromboembolic risk.
JapaneseAnswer: 少なくとも4週間、その後の継続は血栓塞栓リスクで決める。

EnglishQuestion: Should emergency cardioversion be delayed to complete anticoagulation in a hemodynamically unstable patient?
JapaneseQuestion: 血行動態不安定患者で抗凝固準備のため緊急カルディオバージョンを遅らせるべきか？
EnglishAnswer: No. Perform urgent cardioversion without delay and manage anticoagulation as soon as feasible.
JapaneseAnswer: 遅らせない。直ちにカルディオバージョンし、可能な限り速やかに抗凝固を管理する。

EnglishQuestion: Where do ventricular arrhythmias originate, and what QRS pattern do they usually produce?
JapaneseQuestion: 心室性不整脈はどこに起源をもち、通常どのQRSパターンを示すか？
EnglishAnswer: They originate below the His bundle bifurcation and usually produce a wide QRS complex.
JapaneseAnswer: His束分岐部より下に起源をもち、通常幅広いQRSを示す。

EnglishQuestion: What diseases commonly cause ventricular arrhythmias?
JapaneseQuestion: 心室性不整脈の一般的な原因疾患は？
EnglishAnswer: Ischemic heart disease, hypertrophic or dilated cardiomyopathy, congenital heart disease, and inherited arrhythmia syndromes.
JapaneseAnswer: 虚血性心疾患、肥大型・拡張型心筋症、先天性心疾患、遺伝性不整脈症候群。

EnglishQuestion: What ECG features characterize a premature ventricular complex (PVC)?
JapaneseQuestion: 心室期外収縮（PVC）を特徴づける心電図所見は？
EnglishAnswer: An early bizarre QRS >0.12 seconds without a preceding P wave, an oppositely directed T wave, and a full compensatory pause.
JapaneseAnswer: 先行P波のない早期の奇異な0.12秒超の幅広いQRS、QRSと逆向きのT波、完全代償性休止。

EnglishQuestion: How are nonsustained and sustained ventricular tachycardia defined?
JapaneseQuestion: 非持続性と持続性心室頻拍はどう定義するか？
EnglishAnswer: Nonsustained VT is at least 3 consecutive ventricular beats lasting <30 seconds; sustained VT lasts >=30 seconds at a rate >=100/min.
JapaneseAnswer: 非持続性VTは3連発以上で30秒未満、持続性VTは心拍数100/分以上で30秒以上持続する。

EnglishQuestion: What ECG findings support ventricular tachycardia?
JapaneseQuestion: 心室頻拍を支持する心電図所見は？
EnglishAnswer: Wide QRS complexes, AV dissociation, and capture or fusion beats.
JapaneseAnswer: 幅広いQRS、房室解離、捕捉拍または融合拍。

EnglishQuestion: How does monomorphic ventricular tachycardia appear on ECG?
JapaneseQuestion: 単形性心室頻拍は心電図でどう見えるか？
EnglishAnswer: A regular sequence of wide QRS complexes with the same morphology.
JapaneseAnswer: 同じ形態の幅広いQRSが規則的に連続する。

EnglishQuestion: How does ventricular flutter appear on ECG?
JapaneseQuestion: 心室粗動は心電図でどう見えるか？
EnglishAnswer: A regular sinusoidal waveform at 200-350/min without a clear isoelectric line or QRS-T boundary.
JapaneseAnswer: 200〜350/分の規則的な正弦波状波形で、明瞭な等電位線やQRS-T境界がない。

EnglishQuestion: How does ventricular fibrillation appear on ECG and affect cardiac output?
JapaneseQuestion: 心室細動は心電図でどう見え、心拍出量にどう影響するか？
EnglishAnswer: A chaotic waveform without organized QRS complexes and with no effective cardiac output.
JapaneseAnswer: 組織化されたQRSのない無秩序な波形で、有効心拍出量はない。

EnglishQuestion: What defines torsades de pointes?
JapaneseQuestion: トルサード・ド・ポワントを定義するものは？
EnglishAnswer: Polymorphic wide-complex tachycardia associated with long QT, with QRS amplitude and axis twisting around the baseline.
JapaneseAnswer: QT延長に伴う多形性幅広QRS頻拍で、QRS振幅と軸が基線周囲をねじれる。

EnglishQuestion: How should an undifferentiated wide-complex tachycardia be managed when the diagnosis is uncertain?
JapaneseQuestion: 診断不明の幅広QRS頻拍をどう扱うか？
EnglishAnswer: Treat it as ventricular tachycardia for safety.
JapaneseAnswer: 安全のため心室頻拍として扱う。

EnglishQuestion: How rapidly can untreated ventricular fibrillation cause brain injury and death?
JapaneseQuestion: 未治療の心室細動はどの程度速く脳障害と死亡を起こし得るか？
EnglishAnswer: Brain injury may occur within 5 minutes and death within 10-15 minutes.
JapaneseAnswer: 5分以内に脳障害、10〜15分で死亡し得る。

EnglishQuestion: What are major causes of ventricular fibrillation?
JapaneseQuestion: 心室細動の主な原因は？
EnglishAnswer: Coronary artery disease, myocardial infarction, cardiomyopathy, electrical injury or lightning, and hypo- or hyperkalemia.
JapaneseAnswer: 冠動脈疾患、心筋梗塞、心筋症、感電・落雷、低K血症または高K血症。

EnglishQuestion: What is the immediate treatment of pulseless ventricular tachycardia or ventricular fibrillation?
JapaneseQuestion: 無脈性心室頻拍または心室細動の直ちに行う治療は？
EnglishAnswer: CPR and unsynchronized defibrillation.
JapaneseAnswer: 心肺蘇生と非同期除細動。

EnglishQuestion: What is the acute treatment for unstable monomorphic ventricular tachycardia with a pulse?
JapaneseQuestion: 脈のある不安定な単形性心室頻拍の急性治療は？
EnglishAnswer: Urgent synchronized cardioversion.
JapaneseAnswer: 緊急同期下カルディオバージョン。

EnglishQuestion: What is the acute electrical treatment for unstable polymorphic ventricular tachycardia?
JapaneseQuestion: 不安定な多形性心室頻拍の急性電気治療は？
EnglishAnswer: An unsynchronized high-energy shock.
JapaneseAnswer: 非同期高エネルギーショック。

EnglishQuestion: What is the acute management flow for wide-complex tachycardia?
JapaneseQuestion: 幅広QRS頻拍の急性管理の流れは？
EnglishAnswer: Check for a pulse -> if pulseless, CPR and defibrillation -> if a pulse is present, assess stability -> unstable monomorphic VT: synchronized cardioversion; polymorphic VT: unsynchronized shock -> stable cases: ECG, cause evaluation, antiarrhythmic infusion, and expert consultation.
JapaneseAnswer: 脈を確認→無脈なら心肺蘇生と除細動→脈ありなら安定性評価→不安定単形性VT：同期下カルディオバージョン、多形性VT：非同期ショック→安定例：心電図、原因評価、抗不整脈薬持続投与、専門家相談。

EnglishQuestion: Which antiarrhythmic infusions may be used for stable wide-complex tachycardia?
JapaneseQuestion: 安定した幅広QRS頻拍に用い得る抗不整脈薬持続投与は？
EnglishAnswer: Procainamide, amiodarone, or sotalol, with expert consultation.
JapaneseAnswer: プロカインアミド、アミオダロン、ソタロールを専門家相談のもと用いる。

EnglishQuestion: When may adenosine be considered in wide-complex tachycardia?
JapaneseQuestion: 幅広QRS頻拍でアデノシンを検討できるのはいつか？
EnglishAnswer: In a stable, regular, monomorphic rhythm for diagnostic or therapeutic purposes.
JapaneseAnswer: 安定した規則的単形性調律で、診断または治療目的に検討できる。

EnglishQuestion: What is the treatment sequence for torsades de pointes due to acquired long QT?
JapaneseQuestion: 後天性QT延長によるトルサード・ド・ポワントの治療の流れは？
EnglishAnswer: Stop QT-prolonging drugs -> correct potassium and magnesium -> give IV magnesium -> for recurrent pause-dependent episodes, consider overdrive pacing or isoproterenol.
JapaneseAnswer: QT延長薬中止→K・Mg補正→Mg静注→休止依存性に反復する場合はオーバードライブペーシングまたはイソプロテレノールを検討。

EnglishQuestion: Why should verapamil not be given empirically for undifferentiated wide-complex tachycardia?
JapaneseQuestion: 診断不明の幅広QRS頻拍にベラパミルを経験的に投与してはいけないのはなぜか？
EnglishAnswer: It can worsen hemodynamic collapse in typical ventricular tachycardia.
JapaneseAnswer: 通常の心室頻拍では循環虚脱を悪化させ得るため。

EnglishQuestion: What is catheter ablation for arrhythmias?
JapaneseQuestion: 不整脈に対するカテーテルアブレーションとは？
EnglishAnswer: A procedure that identifies an arrhythmogenic focus or circuit by electrophysiologic mapping and selectively inactivates it with thermal or cooling energy.
JapaneseAnswer: 電気生理学的マッピングで不整脈起源または回路を同定し、熱または冷却エネルギーで選択的に失活させる手技。

EnglishQuestion: Where are diagnostic catheters commonly placed during electrophysiologic mapping?
JapaneseQuestion: 電気生理学的マッピングで診断カテーテルを一般にどこへ置くか？
EnglishAnswer: The high right atrium, His bundle region, and right ventricular apex.
JapaneseAnswer: 高位右房、His束領域、右室心尖部。

EnglishQuestion: What information is obtained from bipolar intracardiac signals during ablation?
JapaneseQuestion: アブレーション中の双極心腔内信号から何を得るか？
EnglishAnswer: The activation sequence used to localize the arrhythmogenic focus or circuit.
JapaneseAnswer: 不整脈起源または回路を局在するための興奮順序。

EnglishQuestion: What is the procedural flow of catheter ablation?
JapaneseQuestion: カテーテルアブレーションの手技の流れは？
EnglishAnswer: Electrophysiologic mapping -> identification of the focus or circuit -> delivery of radiofrequency, cryothermal, or laser energy -> scar formation in arrhythmogenic tissue -> elimination of the trigger or reentry circuit.
JapaneseAnswer: 電気生理学的マッピング→起源または回路の同定→高周波・冷凍・レーザーエネルギー照射→不整脈組織の瘢痕化→トリガーまたはリエントリー回路の消失。

EnglishQuestion: How does radiofrequency ablation produce tissue injury?
JapaneseQuestion: 高周波アブレーションはどのように組織障害を起こすか？
EnglishAnswer: A 500-700 kHz alternating current oscillates ions and heats tissue.
JapaneseAnswer: 500〜700 kHzの交流でイオンを振動させ、組織を加熱する。

EnglishQuestion: What tissue effects occur at radiofrequency temperatures below 50 degrees C, above 50 degrees C, and above 80 degrees C?
JapaneseQuestion: 高周波温度が50℃未満、50℃超、80℃超の場合の組織効果は？
EnglishAnswer: Below 50 degrees C causes transient functional loss; above 50 degrees C causes permanent injury; above 80 degrees C increases coagulation and thromboembolism risk.
JapaneseAnswer: 50℃未満では一過性機能消失、50℃超では永久障害、80℃超では凝固と血栓塞栓リスクが増す。

EnglishQuestion: What is the purpose of cooling during cooled radiofrequency ablation?
JapaneseQuestion: 冷却高周波アブレーションで冷却する目的は？
EnglishAnswer: To cool the tissue surface and catheter tip, allowing higher power and a larger lesion.
JapaneseAnswer: 組織表面とカテーテル先端を冷却し、より高出力で大きな病変を形成するため。

EnglishQuestion: How does cryoablation produce tissue injury?
JapaneseQuestion: 冷凍アブレーションはどのように組織障害を起こすか？
EnglishAnswer: Evaporation of liquid nitrous oxide cools the target tissue.
JapaneseAnswer: 液体亜酸化窒素の気化により標的組織を冷却する。

EnglishQuestion: What effects occur at approximately -30 degrees C and -60 degrees C during cryoablation?
JapaneseQuestion: 冷凍アブレーションで約-30℃と-60℃ではどのような効果が起こるか？
EnglishAnswer: Approximately -30 degrees C causes reversible injury; approximately -60 degrees C causes irreversible injury.
JapaneseAnswer: 約-30℃では可逆的障害、約-60℃では不可逆的障害が生じる。

EnglishQuestion: How does laser ablation act on arrhythmogenic tissue?
JapaneseQuestion: レーザーアブレーションは不整脈組織にどう作用するか？
EnglishAnswer: It uses light energy to ablate the target tissue.
JapaneseAnswer: 光エネルギーで標的組織を焼灼する。

EnglishQuestion: Which atrial arrhythmias can be treated with catheter ablation?
JapaneseQuestion: カテーテルアブレーションで治療できる心房性不整脈は？
EnglishAnswer: Atrial tachycardia, atrial flutter, and atrial fibrillation.
JapaneseAnswer: 心房頻拍、心房粗動、心房細動。

EnglishQuestion: Which AV-node- or accessory-pathway-mediated arrhythmias can be treated with catheter ablation?
JapaneseQuestion: カテーテルアブレーションで治療できる房室結節・副伝導路関連不整脈は？
EnglishAnswer: AV nodal reentrant tachycardia and AV reentrant tachycardia, including Wolff-Parkinson-White syndrome.
JapaneseAnswer: 房室結節リエントリー性頻拍と、Wolff-Parkinson-White症候群を含む房室リエントリー性頻拍。

EnglishQuestion: Which ventricular arrhythmia is an indication for catheter ablation?
JapaneseQuestion: カテーテルアブレーションの適応となる心室性不整脈は？
EnglishAnswer: Ventricular tachycardia.
JapaneseAnswer: 心室頻拍。

EnglishQuestion: What are major life-threatening complications of catheter ablation?
JapaneseQuestion: カテーテルアブレーションの主な致死的合併症は？
EnglishAnswer: Death, stroke, and cardiac tamponade.
JapaneseAnswer: 死亡、脳卒中、心タンポナーデ。

EnglishQuestion: What other complications can occur after catheter ablation?
JapaneseQuestion: カテーテルアブレーション後に起こり得るその他の合併症は？
EnglishAnswer: AV block, coronary spasm, radiation exposure, pericarditis, and arrhythmia recurrence.
JapaneseAnswer: 房室ブロック、冠攣縮、放射線曝露、心膜炎、不整脈再発。

EnglishQuestion: What are pacing and sensing in a cardiac pacemaker?
JapaneseQuestion: 心臓ペースメーカーにおけるペーシングとセンシングとは？
EnglishAnswer: Pacing is generator-delivered electrical stimulation that depolarizes the heart; sensing is detection of intrinsic atrial or ventricular depolarization to avoid unnecessary pacing.
JapaneseAnswer: ペーシングはジェネレーターからの電気刺激による心筋脱分極、センシングは不要な刺激を避けるための内因性心房・心室脱分極の検出。

EnglishQuestion: What is the key requirement for permanent pacing in sinus node dysfunction?
JapaneseQuestion: 洞不全症候群で恒久ペーシングを行うための重要要件は？
EnglishAnswer: A demonstrated temporal relationship between symptoms and bradycardia, pauses, or chronotropic incompetence.
JapaneseAnswer: 症状と徐脈、休止、変時性不全との時間的関連が確認されること。

EnglishQuestion: Which acquired AV blocks are major indications for permanent pacing even without symptoms?
JapaneseQuestion: 無症状でも恒久ペーシングの主な適応となる後天性房室ブロックは？
EnglishAnswer: Mobitz II, high-grade, or complete AV block without a reversible or physiologic cause.
JapaneseAnswer: 可逆的・生理的原因のないMobitz II型、高度、または完全房室ブロック。

EnglishQuestion: Which conduction diseases may indicate permanent pacing?
JapaneseQuestion: 恒久ペーシングの適応となり得る伝導疾患は？
EnglishAnswer: Alternating bundle branch block or syncope with documented advanced infranodal disease.
JapaneseAnswer: 交代性脚ブロック、または失神を伴い高度His束下伝導障害が証明された場合。

EnglishQuestion: When is pacing considered in permanent atrial fibrillation?
JapaneseQuestion: 永続性心房細動でペーシングをいつ検討するか？
EnglishAnswer: For a symptomatic slow ventricular response or a clinically significant pause.
JapaneseAnswer: 症候性の遅い心室応答または臨床的に有意な休止がある場合。

EnglishQuestion: When may pacing be considered for reflex syncope?
JapaneseQuestion: 反射性失神でペーシングを検討できるのはいつか？
EnglishAnswer: In selected patients with recurrent unpredictable syncope and a documented asystolic mechanism, such as cardioinhibitory carotid sinus syndrome.
JapaneseAnswer: 再発性で予測不能な失神があり、心抑制型頸動脈洞症候群など心静止機序が確認された選択例。

EnglishQuestion: Which reversible causes should be evaluated before pacemaker implantation?
JapaneseQuestion: ペースメーカー植込み前に評価すべき可逆的原因は？
EnglishAnswer: Drugs, ischemia, electrolyte abnormalities, and endocrine disorders.
JapaneseAnswer: 薬剤、虚血、電解質異常、内分泌異常。

EnglishQuestion: Are asymptomatic or sleep-related bradycardia alone automatic indications for pacemaker implantation?
JapaneseQuestion: 無症候性または睡眠時徐脈だけでペースメーカー植込みの適応となるか？
EnglishAnswer: No. The clinical context, symptoms, and reversible causes must be assessed.
JapaneseAnswer: ならない。臨床背景、症状、可逆的原因を評価する。

EnglishQuestion: What do the five positions of the international pacemaker code represent?
JapaneseQuestion: 国際ペースメーカーコードの5つの位置は何を表すか？
EnglishAnswer: Paced chamber, sensed chamber, response to sensing, rate modulation, and multisite pacing.
JapaneseAnswer: 刺激心腔、感知心腔、感知への応答、レート応答、マルチサイトペーシング。

EnglishQuestion: What do O, A, V, and D mean in the first two positions of the pacemaker code?
JapaneseQuestion: ペースメーカーコードの第1・第2位置におけるO、A、V、Dの意味は？
EnglishAnswer: None, atrium, ventricle, and dual chambers.
JapaneseAnswer: なし、心房、心室、両心腔。

EnglishQuestion: What do I, T, D, and O mean in the third position of the pacemaker code?
JapaneseQuestion: ペースメーカーコード第3位置のI、T、D、Oの意味は？
EnglishAnswer: Inhibited, triggered, dual response, and no response.
JapaneseAnswer: 抑制、トリガー、二重応答、応答なし。

EnglishQuestion: What does R mean in the fourth position of the pacemaker code?
JapaneseQuestion: ペースメーカーコード第4位置のRは何を表すか？
EnglishAnswer: Rate modulation based on detected activity, such as motion, minute ventilation, or acceleration.
JapaneseAnswer: 振動、分時換気量、加速度などで活動を検出してペーシング心拍数を調整するレート応答。

EnglishQuestion: How does VVI(R) pacing operate, and when is it mainly used?
JapaneseQuestion: VVI(R)ペーシングはどう作動し、主にいつ用いるか？
EnglishAnswer: It paces and senses the ventricle and inhibits output after a sensed ventricular event; it is mainly used for permanent AF with bradycardia requiring pacing.
JapaneseAnswer: 心室を刺激・感知し、自己心室興奮で刺激を抑制する。主にペーシング適応の徐脈を伴う永続性AFで用いる。

EnglishQuestion: How does AAI(R) pacing operate, and when is it mainly used?
JapaneseQuestion: AAI(R)ペーシングはどう作動し、主にいつ用いるか？
EnglishAnswer: It paces and senses the atrium and inhibits output after a sensed atrial event; it is used for pure sinus node dysfunction with preserved AV conduction.
JapaneseAnswer: 心房を刺激・感知し、自己心房興奮で刺激を抑制する。房室伝導が保たれた純粋な洞不全症候群で用いる。

EnglishQuestion: How does DDD(R) pacing operate, and when is it mainly used?
JapaneseQuestion: DDD(R)ペーシングはどう作動し、主にいつ用いるか？
EnglishAnswer: It paces and senses both atrium and ventricle with dual response and is used when sinus-node and AV-node dysfunction coexist or AV synchrony must be preserved.
JapaneseAnswer: 心房・心室を刺激・感知し二重応答を行い、洞結節・房室結節機能障害の併存時や房室同期維持が必要な場合に用いる。

EnglishQuestion: What is the mode-selection flow based on atrial activity and AV conduction?
JapaneseQuestion: 心房活動と房室伝導に基づくモード選択の流れは？
EnglishAnswer: No organized atrial activity, such as permanent AF: VVI(R) -> organized atrial activity with preserved AV conduction and pure sinus-node dysfunction: AAI(R) or DDD(R) -> AV block with sinus rhythm: DDD(R) to preserve AV synchrony.
JapaneseAnswer: 永続性AFなど組織化心房活動なし：VVI(R)→組織化心房活動があり房室伝導正常の純粋な洞不全：AAI(R)またはDDD(R)→洞調律で房室ブロック：房室同期維持のためDDD(R)。

EnglishQuestion: What additional factors should influence pacemaker mode selection?
JapaneseQuestion: ペースメーカーモード選択に影響する追加要因は？
EnglishAnswer: Future AV block risk, chronotropic incompetence, expected ventricular pacing burden, and left ventricular function.
JapaneseAnswer: 将来の房室ブロックリスク、変時性不全、予測心室ペーシング率、左室機能。

EnglishQuestion: When should CRT or conduction-system pacing be considered in a patient needing pacing?
JapaneseQuestion: ペーシングを要する患者でCRTまたは刺激伝導系ペーシングをいつ検討するか？
EnglishAnswer: When a high ventricular pacing burden is expected, especially with left ventricular dysfunction.
JapaneseAnswer: 高い心室ペーシング率が予測され、特に左室機能障害がある場合。

EnglishQuestion: Where are transvenous atrial and ventricular pacemaker leads usually placed?
JapaneseQuestion: 経静脈心房・心室ペースメーカーリードは通常どこへ留置するか？
EnglishAnswer: The atrial lead is usually placed in the right atrial appendage; the ventricular lead may be placed at the right ventricular apex, outflow tract, or septum.
JapaneseAnswer: 心房リードは通常右心耳、心室リードは右室心尖部、流出路、または中隔に留置する。

EnglishQuestion: What should be checked sequentially on chest radiography after pacemaker implantation?
JapaneseQuestion: ペースメーカー植込み後、胸部X線で順に何を確認するか？
EnglishAnswer: The generator pocket, venous access, atrial lead, and ventricular lead positions, while assessing for pneumothorax, lead dislodgement, or fracture.
JapaneseAnswer: ジェネレーターポケット、静脈アクセス、心房リード、心室リード位置を順に確認し、気胸、リード脱落、断線を評価する。

EnglishQuestion: What are major implantation-related pacemaker complications?
JapaneseQuestion: ペースメーカー植込みに関連する主な合併症は？
EnglishAnswer: Infection, endocarditis, pneumothorax, hematoma, lead dislodgement, and venous thrombosis.
JapaneseAnswer: 感染、心内膜炎、気胸、血腫、リード脱落、静脈血栓症。

EnglishQuestion: What causes pacemaker syndrome?
JapaneseQuestion: ペースメーカー症候群の原因は？
EnglishAnswer: Loss of AV synchrony, often during VVI pacing, causing atrial contraction against closed AV valves.
JapaneseAnswer: VVIペーシングなどで房室同期が失われ、閉鎖した房室弁に対して心房が収縮すること。

EnglishQuestion: Which device malfunctions and external factors require ongoing pacemaker surveillance?
JapaneseQuestion: 継続的なペースメーカー監視を要するデバイス異常・外的要因は？
EnglishAnswer: Exit block, pacemaker-mediated tachycardia, battery depletion, electromagnetic interference, and under- or oversensing.
JapaneseAnswer: 出口ブロック、ペースメーカー介在性頻拍、電池消耗、電磁干渉、アンダーセンシング・オーバーセンシング。

EnglishQuestion: What are the primary functions of an implantable cardioverter-defibrillator (ICD)?
JapaneseQuestion: 植込み型除細動器（ICD）の主な機能は？
EnglishAnswer: It senses and treats ventricular tachycardia or ventricular fibrillation with pacing or shock and also provides pacemaker functions.
JapaneseAnswer: 心室頻拍・心室細動を検出し、ペーシングまたはショックで治療し、ペースメーカー機能も提供する。

EnglishQuestion: Where are the generator and principal lead of a transvenous ICD placed?
JapaneseQuestion: 経静脈ICDのジェネレーターと主要リードはどこに置くか？
EnglishAnswer: The generator is placed below the clavicle, and a pacing, sensing, and defibrillation lead is placed at least in the right ventricle.
JapaneseAnswer: ジェネレーターは鎖骨下に置き、少なくとも右室にペーシング・センシング・除細動リードを留置する。

EnglishQuestion: What is a major secondary-prevention indication for an ICD?
JapaneseQuestion: ICDの主な二次予防適応は？
EnglishAnswer: Survival after cardiac arrest caused by VT or VF not explained solely by a reversible cause, or selected sustained VT.
JapaneseAnswer: 可逆的原因だけでは説明できないVT・VFによる心停止からの生存、または選択された持続性VT。

EnglishQuestion: What is a representative primary-prevention indication for an ICD in cardiomyopathy?
JapaneseQuestion: 心筋症におけるICD一次予防の代表的適応は？
EnglishAnswer: Ischemic or nonischemic cardiomyopathy with LVEF <=35% despite adequate guideline-directed medical therapy, after considering timing after MI, NYHA class, and expected survival.
JapaneseAnswer: 十分なガイドライン推奨薬物治療後もLVEF 35%以下の虚血性・非虚血性心筋症で、心筋梗塞後の時期、NYHA分類、期待余命を考慮する。

EnglishQuestion: How is ICD candidacy assessed in inherited or structural heart disease?
JapaneseQuestion: 遺伝性・構造的心疾患でICD適応をどう評価するか？
EnglishAnswer: Use disease-specific sudden cardiac death risk factors, such as those for hypertrophic cardiomyopathy or long-QT syndrome.
JapaneseAnswer: 肥大型心筋症やQT延長症候群など、疾患固有の突然心臓死危険因子を用いる。

EnglishQuestion: Why should an ICD not be implanted solely because a patient has heart failure, low LVEF, or hypertrophic cardiomyopathy?
JapaneseQuestion: 心不全、LVEF低下、肥大型心筋症という診断だけでICDを植え込んではいけないのはなぜか？
EnglishAnswer: The decision must integrate reversible causes, reassessment after therapy, expected functional survival of more than 1 year, device complications, and patient preference.
JapaneseAnswer: 可逆的原因、治療後の再評価、1年以上の良好な機能的生存見込み、デバイス合併症、患者希望を統合する必要があるため。

EnglishQuestion: How do transvenous and subcutaneous ICDs differ?
JapaneseQuestion: 経静脈ICDと皮下ICDはどう異なるか？
EnglishAnswer: A transvenous ICD has intracardiac leads and can provide pacing and defibrillation; a subcutaneous ICD avoids intracardiac leads but lacks the usual pacing functions.
JapaneseAnswer: 経静脈ICDは心内リードでペーシングと除細動が可能だが、皮下ICDは心内リードを避ける代わりに通常のペーシング機能をもたない。

EnglishQuestion: How is the shock vector created in a subcutaneous ICD?
JapaneseQuestion: 皮下ICDではどのようにショックベクトルを作るか？
EnglishAnswer: A left lateral chest generator and a parasternal subcutaneous electrode bracket the heart without entering the vasculature or cardiac chambers.
JapaneseAnswer: 左側胸部ジェネレーターと胸骨傍皮下電極で心臓を挟み、血管・心腔内にリードを入れずショックベクトルを作る。

EnglishQuestion: Which patients are unsuitable for a subcutaneous ICD?
JapaneseQuestion: 皮下ICDが不向きな患者は？
EnglishAnswer: Patients who need sustained bradycardia pacing, conventional antitachycardia pacing, or cardiac resynchronization therapy.
JapaneseAnswer: 持続的徐脈ペーシング、通常の抗頻拍ペーシング、心臓再同期療法を必要とする患者。

EnglishQuestion: What is the principal therapeutic goal of cardiac resynchronization therapy (CRT)?
JapaneseQuestion: 心臓再同期療法（CRT）の主な治療目的は？
EnglishAnswer: To correct ventricular contraction dyssynchrony by appropriately timed biventricular pacing.
JapaneseAnswer: 適切なタイミングの両心室ペーシングで心室収縮の同期不全を補正する。

EnglishQuestion: What is the strongest representative CRT indication described in the source?
JapaneseQuestion: 代表的な強いCRT適応は？
EnglishAnswer: Symptomatic HFrEF despite adequate guideline-directed therapy, LVEF <=35%, and prolonged QRS, especially sinus rhythm with LBBB morphology and QRS >=150 ms.
JapaneseAnswer: 十分な薬物治療後も症候性HFrEFがあり、LVEF 35%以下かつQRS延長、特に洞調律でLBBB形態・QRS 150 ms以上。

EnglishQuestion: Which variables modify the strength of a CRT recommendation?
JapaneseQuestion: CRT推奨度を修飾する要因は？
EnglishAnswer: QRS duration and morphology, atrial fibrillation, and the expected burden of right ventricular pacing.
JapaneseAnswer: QRS幅と形態、心房細動、予測右室ペーシング率。

EnglishQuestion: How do CRT-D and CRT-P differ?
JapaneseQuestion: CRT-DとCRT-Pはどう異なるか？
EnglishAnswer: CRT-D combines resynchronization with defibrillator therapy; CRT-P provides resynchronization pacing without defibrillation.
JapaneseAnswer: CRT-Dは再同期と除細動機能を組み合わせ、CRT-Pは除細動なしで再同期ペーシングを行う。

EnglishQuestion: Which factors guide the choice between CRT-D and CRT-P?
JapaneseQuestion: CRT-DとCRT-Pの選択を導く要因は？
EnglishAnswer: Sudden-death risk, comorbidities, prognosis, and patient preference.
JapaneseAnswer: 突然死リスク、併存疾患、予後、患者希望。

EnglishQuestion: Where are the three leads usually positioned in CRT?
JapaneseQuestion: CRTの3本のリードは通常どこに配置するか？
EnglishAnswer: In the right atrium, right ventricle, and a cardiac vein reached through the coronary sinus for left ventricular pacing.
JapaneseAnswer: 右房、右室、左室ペーシング用に冠静脈洞経由で到達する心静脈。

EnglishQuestion: Does the left ventricular CRT lead usually sit directly inside the left ventricular cavity?
JapaneseQuestion: CRTの左室リードは通常、左室腔内に直接置くか？
EnglishAnswer: No. It is usually positioned in a cardiac vein through the coronary sinus.
JapaneseAnswer: 置かない。通常は冠静脈洞経由で心静脈に留置する。

EnglishQuestion: What is the physiologic flow by which CRT improves heart failure?
JapaneseQuestion: CRTが心不全を改善する生理学的な流れは？
EnglishAnswer: Wide LBBB -> delayed and nonuniform left ventricular depolarization -> ventricular dyssynchrony -> appropriately timed right and left ventricular pacing -> improved coordinated contraction -> increased cardiac output and reduced heart-failure symptoms.
JapaneseAnswer: 幅広いLBBB→左室脱分極の遅延・不均一→心室同期不全→右室・左室を適切なタイミングでペーシング→協調収縮改善→心拍出量増加・心不全症状軽減。

EnglishQuestion: Why is the left ventricular lateral wall an important target of CRT timing in LBBB?
JapaneseQuestion: LBBBで左室側壁がCRTタイミングの重要標的となるのはなぜか？
EnglishAnswer: It contracts late because of delayed depolarization, so resynchronizing it can improve coordinated ventricular contraction.
JapaneseAnswer: 脱分極遅延により収縮が遅れるため、再同期によって心室の協調収縮を改善できる。

EnglishQuestion: What combined roles does a CRT device with defibrillator capability perform?
JapaneseQuestion: 除細動機能付きCRTデバイスはどの2つの役割を担うか？
EnglishAnswer: Ventricular resynchronization and treatment of life-threatening ventricular arrhythmias.
JapaneseAnswer: 心室再同期と致死性心室性不整脈の治療。

EnglishQuestion: What is the general purpose of noncoronary structural cardiac interventions?
JapaneseQuestion: 非冠動脈性構造的心疾患へのカテーテル治療の一般的な目的は？
EnglishAnswer: To replace or repair a valve or close the left atrial appendage using a less invasive catheter-based approach, especially when open surgery is difficult.
JapaneseAnswer: 特に開心術が困難な患者で、低侵襲なカテーテルにより弁を置換・修復し、または左心耳を閉鎖すること。

EnglishQuestion: What is the principal indication for transcatheter aortic valve implantation (TAVI)?
JapaneseQuestion: 経カテーテル的大動脈弁留置術（TAVI）の主な適応は？
EnglishAnswer: Severe aortic stenosis for which valve intervention is indicated.
JapaneseAnswer: 弁介入適応のある重症大動脈弁狭窄症。

EnglishQuestion: Which factors guide the choice between TAVI and surgical aortic valve replacement?
JapaneseQuestion: TAVIと外科的大動脈弁置換術の選択を導く要因は？
EnglishAnswer: Age, life expectancy, surgical risk, anatomy, comorbidities, and patient preference, integrated by the Heart Team.
JapaneseAnswer: 年齢、余命、手術リスク、解剖、併存疾患、患者希望をHeart Teamで統合する。

EnglishQuestion: What is the procedural sequence of transfemoral TAVI?
JapaneseQuestion: 経大腿TAVIの手技の流れは？
EnglishAnswer: Femoral arterial access -> advance a guidewire across the aortic valve into the left ventricle -> balloon predilation when needed -> position a compressed tissue valve -> deploy a balloon-expandable or self-expanding valve.
JapaneseAnswer: 大腿動脈アクセス→ガイドワイヤーを大動脈弁越しに左室へ→必要時バルーン前拡張→圧縮した生体弁を配置→バルーン拡張型または自己拡張型弁を展開。

EnglishQuestion: Is balloon valvuloplasty mandatory before every TAVI procedure?
JapaneseQuestion: すべてのTAVIで事前のバルーン弁形成術は必須か？
EnglishAnswer: No. Predilation is optional depending on the device and anatomy.
JapaneseAnswer: 必須ではない。デバイスと解剖に応じて選択する。

EnglishQuestion: How do balloon-expandable and self-expanding TAVI valves differ in deployment?
JapaneseQuestion: バルーン拡張型と自己拡張型TAVI弁は展開方法がどう異なるか？
EnglishAnswer: One is expanded by balloon inflation; the other expands by its own frame properties.
JapaneseAnswer: 一方はバルーン拡張で、他方はフレーム自体の性質で展開する。

EnglishQuestion: What is the preferred TAVI access route when anatomically feasible?
JapaneseQuestion: 解剖学的に可能な場合のTAVI第一選択アクセスは？
EnglishAnswer: Transfemoral access.
JapaneseAnswer: 経大腿アクセス。

EnglishQuestion: How do transfemoral, transaortic, and transapical TAVI routes differ?
JapaneseQuestion: 経大腿、経大動脈、経心尖TAVIルートはどう異なるか？
EnglishAnswer: Transfemoral travels through the femoral and iliac arteries to the aorta and is least invasive; transaortic directly accesses the ascending aorta through the chest; transapical punctures the left ventricular apex through a small thoracotomy and is more invasive.
JapaneseAnswer: 経大腿は大腿・腸骨動脈から大動脈へ進み最も低侵襲、経大動脈は胸部から上行大動脈へ直接アクセス、経心尖は小開胸で左室心尖を穿刺し、より侵襲的。

EnglishQuestion: What are major complications of TAVI?
JapaneseQuestion: TAVIの主な合併症は？
EnglishAnswer: Death, stroke, annular rupture, bleeding, vascular complications, paravalvular regurgitation, conduction block requiring pacemaker implantation, and acute kidney injury.
JapaneseAnswer: 死亡、脳卒中、弁輪破裂、出血、血管合併症、弁周囲逆流、ペースメーカー植込みを要する伝導ブロック、急性腎障害。

EnglishQuestion: How does MitraClip reduce mitral regurgitation?
JapaneseQuestion: MitraClipはどのように僧帽弁逆流を減らすか？
EnglishAnswer: It grasps and joins the two mitral leaflets, reducing the regurgitant orifice.
JapaneseAnswer: 僧帽弁の両弁尖を把持・接合し、逆流口を縮小する。

EnglishQuestion: Does MitraClip replace the mitral valve?
JapaneseQuestion: MitraClipは僧帽弁を置換するか？
EnglishAnswer: No. It is a repair that approximates the leaflets to reduce regurgitation.
JapaneseAnswer: 置換しない。弁尖を接合して逆流を減らす修復術である。

EnglishQuestion: Which patients may be considered for MitraClip?
JapaneseQuestion: MitraClipを検討し得る患者は？
EnglishAnswer: Patients with suitable anatomy and severe mitral regurgitation, including high-surgical-risk primary MR or selected symptomatic secondary MR despite adequate medical and device therapy.
JapaneseAnswer: 適切な解剖をもつ重症僧帽弁逆流で、手術高リスクの原発性MR、または十分な薬物・デバイス治療後も症候性の選択された二次性MR患者。

EnglishQuestion: What is the catheter route for MitraClip placement?
JapaneseQuestion: MitraClip留置のカテーテルルートは？
EnglishAnswer: Femoral venous access -> right atrium -> transseptal puncture -> left atrium -> mitral leaflets under TEE guidance.
JapaneseAnswer: 大腿静脈アクセス→右房→経中隔穿刺→左房→TEE誘導下に僧帽弁尖へ。

EnglishQuestion: What must be assessed with TEE during MitraClip treatment?
JapaneseQuestion: MitraClip治療中にTEEで何を評価するか？
EnglishAnswer: Leaflet capture, residual mitral regurgitation, and any resulting mitral stenosis.
JapaneseAnswer: 弁尖把持、残存僧帽弁逆流、治療により生じる僧帽弁狭窄。

EnglishQuestion: What are major complications of MitraClip?
JapaneseQuestion: MitraClipの主な合併症は？
EnglishAnswer: Vascular or cardiac injury, clip dislodgement, myocardial infarction, infection, death, and stroke.
JapaneseAnswer: 血管・心臓損傷、クリップ脱落、心筋梗塞、感染、死亡、脳卒中。

EnglishQuestion: What is the main clinical purpose of percutaneous left atrial appendage closure?
JapaneseQuestion: 経皮的左心耳閉鎖術の主な臨床目的は？
EnglishAnswer: To prevent thrombus embolization and stroke in atrial fibrillation when long-term anticoagulation cannot be used.
JapaneseAnswer: 長期抗凝固療法を使用できない心房細動患者で、血栓塞栓と脳卒中を予防する。

EnglishQuestion: What is the catheter route for percutaneous left atrial appendage closure?
JapaneseQuestion: 経皮的左心耳閉鎖術のカテーテルルートは？
EnglishAnswer: Femoral venous access -> right atrium -> transseptal puncture -> left atrium -> deployment of a plug at the left atrial appendage ostium under fluoroscopic, contrast, and echocardiographic guidance.
JapaneseAnswer: 大腿静脈アクセス→右房→経中隔穿刺→左房→X線・造影・心エコー誘導下に左心耳開口部へプラグを展開。

EnglishQuestion: What happens to a left atrial appendage closure device over time?
JapaneseQuestion: 左心耳閉鎖デバイスは時間とともにどうなるか？
EnglishAnswer: Tissue grows over its surface.
JapaneseAnswer: 表面が組織で被覆される。

EnglishQuestion: What must be confirmed when deploying a left atrial appendage closure device?
JapaneseQuestion: 左心耳閉鎖デバイス展開時に何を確認するか？
EnglishAnswer: Device position, compression, and seal.
JapaneseAnswer: デバイスの位置、圧縮、密閉。

EnglishQuestion: What complications require follow-up after left atrial appendage closure?
JapaneseQuestion: 左心耳閉鎖後に追跡すべき合併症は？
EnglishAnswer: Peri-device leak, device-related thrombus, cardiac injury, incomplete closure, device dislodgement, death, and stroke.
JapaneseAnswer: デバイス周囲漏れ、デバイス関連血栓、心構造損傷、不完全閉鎖、デバイス脱落、死亡、脳卒中。

EnglishQuestion: How do the catheter routes for TAVI, MitraClip, and left atrial appendage closure differ?
JapaneseQuestion: TAVI、MitraClip、左心耳閉鎖術のカテーテルルートはどう異なるか？
EnglishAnswer: TAVI usually uses arterial access to reach the aortic valve; MitraClip and percutaneous left atrial appendage closure use venous access, enter the right atrium, and cross the interatrial septum into the left atrium.
JapaneseAnswer: TAVIは通常動脈アクセスで大動脈弁へ進み、MitraClipと経皮的左心耳閉鎖は静脈アクセスから右房へ入り、心房中隔を越えて左房へ進む。

EnglishQuestion: Match TAVI, MitraClip, and left atrial appendage closure to their targets and purposes.
JapaneseQuestion: TAVI、MitraClip、左心耳閉鎖術を標的と目的に対応させよ。
EnglishAnswer: TAVI: aortic valve replacement; MitraClip: mitral leaflet repair to reduce regurgitation; left atrial appendage closure: occlusion of the appendage opening to prevent thromboembolic stroke.
JapaneseAnswer: TAVI：大動脈弁置換、MitraClip：僧帽弁尖修復による逆流軽減、左心耳閉鎖：左心耳開口部閉鎖による血栓塞栓性脳卒中予防。

EnglishQuestion: What is the key treatment concept for aortic stenosis and aortic regurgitation?
JapaneseQuestion: 大動脈弁狭窄症と大動脈弁閉鎖不全症の治療概念は？
EnglishAnswer: In aortic stenosis, replace the obstructed outlet; in aortic regurgitation, intervene before chronic volume overload causes irreversible left ventricular damage.
JapaneseAnswer: 大動脈弁狭窄症では狭い流出口を置換し、大動脈弁閉鎖不全症では慢性容量負荷による左室障害が不可逆になる前に介入する。

EnglishQuestion: What is the definitive treatment for severe aortic stenosis?
JapaneseQuestion: 重症大動脈弁狭窄症の根治的治療は？
EnglishAnswer: Aortic valve replacement (AVR).
JapaneseAnswer: 大動脈弁置換術（AVR）。

EnglishQuestion: What is the principal intervention indication in symptomatic severe aortic stenosis?
JapaneseQuestion: 症候性重症大動脈弁狭窄症の主な介入適応は？
EnglishAnswer: Symptoms attributable to severe aortic stenosis are an indication for aortic valve replacement.
JapaneseAnswer: 重症大動脈弁狭窄症に起因する症状があれば大動脈弁置換術の適応となる。

EnglishQuestion: Which findings can justify intervention in asymptomatic severe aortic stenosis?
JapaneseQuestion: 無症候性重症大動脈弁狭窄症で介入を検討する所見は？
EnglishAnswer: Reduced left ventricular ejection fraction, symptoms or an abnormal blood pressure response during exercise testing, or very severe stenosis.
JapaneseAnswer: 左室駆出率低下、運動負荷での症状または異常血圧反応、超重症狭窄所見。

EnglishQuestion: Is isolated aortic valve replacement usually indicated for moderate aortic stenosis?
JapaneseQuestion: 中等度大動脈弁狭窄症に単独の大動脈弁置換術は通常適応となるか？
EnglishAnswer: No. It is generally considered only when another cardiac operation is being performed or in another selected setting.
JapaneseAnswer: 通常は適応とならず、別の心臓手術を同時に行う場合などに検討する。

EnglishQuestion: Why is a bioprosthetic aortic valve often selected in older patients?
JapaneseQuestion: 高齢者で大動脈弁の生体弁が選ばれやすい理由は？
EnglishAnswer: Its durability may be sufficient relative to life expectancy, and it avoids the need for lifelong anticoagulation required by a mechanical valve.
JapaneseAnswer: 期待余命に対して耐久性が十分なことが多く、機械弁で必要となる長期抗凝固を避けられるため。

EnglishQuestion: How does transcatheter aortic valve implantation (TAVI) treat aortic stenosis?
JapaneseQuestion: 経カテーテル的大動脈弁留置術（TAVI）はどのように大動脈弁狭窄症を治療するか？
EnglishAnswer: A bioprosthetic valve mounted on a stent frame is expanded within the native stenotic valve, displacing the calcified leaflets outward and anchoring the prosthesis.
JapaneseAnswer: ステントフレーム上の生体弁を狭窄した自己弁内で展開し、石灰化弁尖を外側へ押し広げて固定する。

EnglishQuestion: How do transfemoral, transapical, and transaortic TAVI access routes differ?
JapaneseQuestion: TAVIのtransfemoral、transapical、transaortic accessはどう異なるか？
EnglishAnswer: Transfemoral access approaches retrogradely through the femoral artery; transapical access approaches antegradely through the left ventricular apex; transaortic access enters directly through the ascending aorta.
JapaneseAnswer: Transfemoralは大腿動脈から逆行性、transapicalは左室心尖部から順行性、transaorticは上行大動脈から直接進入する。

EnglishQuestion: Which TAVI access route is preferred when anatomically feasible?
JapaneseQuestion: 解剖学的に可能な場合に優先されるTAVI accessは？
EnglishAnswer: Transfemoral access.
JapaneseAnswer: 経大腿動脈access（transfemoral access）。

EnglishQuestion: Which factors should the Heart Team integrate when choosing between TAVI and surgical aortic valve replacement?
JapaneseQuestion: TAVIと外科的大動脈弁置換術の選択でHeart Teamが統合する要因は？
EnglishAnswer: Age, life expectancy, surgical risk, transfemoral feasibility, bicuspid valve anatomy, aortic root and coronary anatomy, need for CABG or other valve surgery, and future reintervention.
JapaneseAnswer: 年齢、期待余命、外科リスク、transfemoral accessの可否、二尖弁、大動脈基部・冠動脈解剖、CABGや他弁手術の必要性、将来の再介入。

EnglishQuestion: Which findings tend to support surgical rather than transcatheter aortic valve replacement?
JapaneseQuestion: TAVIより外科的大動脈弁置換術を支持する所見は？
EnglishAnswer: Anatomy unsuitable for TAVI, an intracardiac or aortic mass, infective endocarditis, or low surgical risk.
JapaneseAnswer: TAVIに不適な解剖、左室・大動脈内腫瘤、感染性心内膜炎、低い外科リスク。

EnglishQuestion: Which findings tend to support TAVI rather than surgical aortic valve replacement?
JapaneseQuestion: 外科的大動脈弁置換術よりTAVIを支持する所見は？
EnglishAnswer: A patent LIMA graft, chest-wall deformity, previous thoracic radiotherapy, or high surgical risk.
JapaneseAnswer: 開存LIMA graft、胸郭変形、胸部放射線治療歴、高い外科リスク。

EnglishQuestion: Why does a patent LIMA graft not determine the choice of TAVI by itself?
JapaneseQuestion: 開存LIMA graftだけでTAVIを選択できないのはなぜか？
EnglishAnswer: It increases the risk of repeat sternotomy but is only one factor; CT must also assess access, annular anatomy, coronary height, and graft course.
JapaneseAnswer: 再開胸リスクを高める一要因にすぎず、CTでaccess、弁輪、冠動脈高、graft走行も評価する必要があるため。

EnglishQuestion: How does balloon aortic valvuloplasty differ from TAVI?
JapaneseQuestion: バルーン大動脈弁形成術とTAVIの違いは？
EnglishAnswer: Balloon valvuloplasty temporarily enlarges the native valve opening without implanting a new valve, whereas TAVI implants a bioprosthetic valve.
JapaneseAnswer: バルーン形成術は新しい弁を留置せず自己弁口を一時的に拡大するが、TAVIは生体弁を留置する。

EnglishQuestion: What are the current roles of balloon aortic valvuloplasty?
JapaneseQuestion: 現在のバルーン大動脈弁形成術の役割は？
EnglishAnswer: A bridge to surgical or transcatheter valve replacement in unstable patients, or temporary symptom relief in selected patients unable to receive definitive treatment.
JapaneseAnswer: 不安定例でSAVRまたはTAVIまでの橋渡し、あるいは根治治療不能な選択例での一時的症状緩和。

EnglishQuestion: Can medication cure aortic stenosis?
JapaneseQuestion: 薬物療法で大動脈弁狭窄症を根治できるか？
EnglishAnswer: No. Medication, including cautious diuretic use while awaiting intervention, provides symptom relief only.
JapaneseAnswer: できない。介入待機中の慎重な利尿薬使用を含め、薬物療法は症状緩和にとどまる。

EnglishQuestion: Which echocardiographic variables should be followed in chronic severe aortic regurgitation?
JapaneseQuestion: 慢性重症大動脈弁閉鎖不全症で追跡する心エコー指標は？
EnglishAnswer: Regurgitation severity, left ventricular ejection fraction, left ventricular end-systolic diameter, and their trends over time.
JapaneseAnswer: 逆流重症度、左室駆出率、左室収縮末期径、およびそれらの経時変化。

EnglishQuestion: What is the role of medical therapy in chronic aortic regurgitation?
JapaneseQuestion: 慢性大動脈弁閉鎖不全症における薬物療法の役割は？
EnglishAnswer: Treat hypertension with an ACE inhibitor, ARB, or dihydropyridine calcium channel blocker and congestion with a loop diuretic, but do not use these treatments as a substitute for indicated valve replacement.
JapaneseAnswer: 高血圧にはACE阻害薬、ARB、dihydropyridine系Ca拮抗薬、うっ血にはloop利尿薬を用いるが、手術適応例の弁置換を代替しない。

EnglishQuestion: What is the valve-replacement indication in symptomatic severe aortic regurgitation?
JapaneseQuestion: 症候性重症大動脈弁閉鎖不全症の弁置換適応は？
EnglishAnswer: Aortic valve replacement is indicated regardless of left ventricular ejection fraction.
JapaneseAnswer: 左室駆出率にかかわらず大動脈弁置換術の適応となる。

EnglishQuestion: Which left ventricular thresholds support surgery in asymptomatic severe aortic regurgitation?
JapaneseQuestion: 無症候性重症大動脈弁閉鎖不全症で手術を支持する左室基準は？
EnglishAnswer: Reduced LVEF, commonly <=55% in ACC/AHA guidance or <=50% in ESC guidance, or marked dilatation with LVESD >50 mm or indexed LVESD >25 mm/m2; progressive worsening also matters.
JapaneseAnswer: LVEF低下（ACC/AHAでは55%以下、ESCでは50%以下が代表的）またはLVESD 50 mm超、LVESD index 25 mm/m2超の高度拡大で、経時的悪化も重視する。

EnglishQuestion: How is acute severe aortic regurgitation treated?
JapaneseQuestion: 急性重症大動脈弁閉鎖不全症はどう治療するか？
EnglishAnswer: Emergency surgery.
JapaneseAnswer: 緊急手術。

EnglishQuestion: What is the intervention flow for severe aortic valve disease?
JapaneseQuestion: 重症大動脈弁疾患の介入フローは？
EnglishAnswer: For severe aortic stenosis meeting intervention criteria, choose surgical AVR or TAVI according to Heart Team assessment; for aortic regurgitation, assess symptoms, LV dysfunction, and LV dilatation, perform AVR for chronic severe disease meeting criteria, and operate emergently in acute severe disease.
JapaneseAnswer: 介入基準を満たす重症ASではHeart Team評価によりSAVRまたはTAVIを選択する。ARでは症状、左室機能障害、左室拡大を評価し、基準を満たす慢性重症例はAVR、急性重症例は緊急手術とする。

EnglishQuestion: What is the key treatment concept for mitral stenosis and mitral regurgitation?
JapaneseQuestion: 僧帽弁狭窄症と僧帽弁閉鎖不全症の治療概念は？
EnglishAnswer: Open the stenotic mitral orifice in mitral stenosis; in mitral regurgitation, stop regurgitation while preserving the valve whenever durable repair is possible.
JapaneseAnswer: 僧帽弁狭窄症では弁口を開き、僧帽弁閉鎖不全症では耐久性ある修復が可能なら弁を温存して逆流を止める。

EnglishQuestion: What conservative treatment is used for mild mitral stenosis?
JapaneseQuestion: 軽症僧帽弁狭窄症の保存的治療は？
EnglishAnswer: Diuretics and salt restriction.
JapaneseAnswer: 利尿薬と塩分制限。

EnglishQuestion: How is atrial fibrillation managed when it accompanies mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄症に心房細動を合併した場合の管理は？
EnglishAnswer: Control the ventricular rate with digoxin, a beta blocker, or a calcium channel blocker, and provide anticoagulation.
JapaneseAnswer: Digoxin、beta blocker、calcium channel blockerで心拍数を調節し、抗凝固療法を行う。

EnglishQuestion: What is the access sequence for percutaneous mitral commissurotomy?
JapaneseQuestion: 経皮的僧帽弁交連切開術のaccess順序は？
EnglishAnswer: Enter through the venous system into the right atrium, cross the atrial septum by transseptal puncture, enter the left atrium, pass the balloon across the mitral valve, and inflate it.
JapaneseAnswer: 静脈系から右房へ入り、心房中隔穿刺で左房へ進み、僧帽弁口を越えたballoonを拡張する。

EnglishQuestion: What structure is opened by balloon mitral commissurotomy?
JapaneseQuestion: バルーン僧帽弁交連切開術で開く構造は？
EnglishAnswer: Fused mitral commissures; the procedure does not remove calcification from the valve.
JapaneseAnswer: 癒合した僧帽弁交連であり、石灰化を削り取る手技ではない。

EnglishQuestion: What are the main indications for percutaneous mitral commissurotomy?
JapaneseQuestion: 経皮的僧帽弁交連切開術の主な適応は？
EnglishAnswer: Symptomatic severe mitral stenosis with favorable valve morphology and without severe mitral regurgitation or left atrial thrombus.
JapaneseAnswer: 弁形態が適した症候性重症僧帽弁狭窄症で、高度僧帽弁逆流や左房内血栓がない場合。

EnglishQuestion: Which findings make balloon treatment unsuitable in severe mitral stenosis?
JapaneseQuestion: 重症僧帽弁狭窄症でballoon治療を不適にする所見は？
EnglishAnswer: Unfavorable valve morphology, left atrial thrombus, or severe mitral regurgitation.
JapaneseAnswer: 不適な弁形態、左房内血栓、高度僧帽弁逆流。

EnglishQuestion: What are the major complications of percutaneous mitral commissurotomy?
JapaneseQuestion: 経皮的僧帽弁交連切開術の主な合併症は？
EnglishAnswer: New or worsened mitral regurgitation, cardiac tamponade, embolism, and a residual atrial septal communication.
JapaneseAnswer: 新規または増悪する僧帽弁逆流、心タンポナーデ、塞栓、心房中隔交通の残存。

EnglishQuestion: What is the next step when balloon commissurotomy is unsuitable or unsuccessful?
JapaneseQuestion: Balloon交連切開術が不適または不成功の場合の次の治療は？
EnglishAnswer: Consider surgery.
JapaneseAnswer: 手術を検討する。

EnglishQuestion: How do closed and open mitral valvotomy differ?
JapaneseQuestion: Closed mitral valvotomyとopen mitral valvotomyの違いは？
EnglishAnswer: Closed valvotomy separates fused leaflets without direct visualization; open valvotomy separates them under direct vision using cardiopulmonary bypass.
JapaneseAnswer: Closed valvotomyは非直視下、open valvotomyは人工心肺下の直視下で癒合弁尖を分離する。

EnglishQuestion: When is mitral valve replacement used instead of repair in mitral stenosis?
JapaneseQuestion: 僧帽弁狭窄症で修復ではなく弁置換を行うのはいつか？
EnglishAnswer: When the valve cannot be adequately repaired.
JapaneseAnswer: 十分な弁修復ができない場合。

EnglishQuestion: What is the role of diuretics and vasodilators in acute mitral regurgitation or mitral regurgitation with heart failure or hypertension?
JapaneseQuestion: 急性僧帽弁逆流、または心不全・高血圧を伴う僧帽弁逆流での利尿薬と血管拡張薬の役割は？
EnglishAnswer: They adjust preload and afterload according to the hemodynamic state but do not correct the chronic primary valve lesion.
JapaneseAnswer: 病態に応じて前負荷と後負荷を調整するが、慢性一次性弁病変そのものは治さない。

EnglishQuestion: Can medication alone cure chronic primary mitral regurgitation?
JapaneseQuestion: 慢性一次性僧帽弁閉鎖不全症を薬物療法だけで根治できるか？
EnglishAnswer: No.
JapaneseAnswer: できない。

EnglishQuestion: Which findings support early intervention in severe primary mitral regurgitation?
JapaneseQuestion: 重症一次性僧帽弁閉鎖不全症で早期介入を支持する所見は？
EnglishAnswer: Symptoms, left ventricular dysfunction or enlargement, pulmonary hypertension, and atrial fibrillation.
JapaneseAnswer: 症状、左室機能低下または拡大、肺高血圧、心房細動。

EnglishQuestion: Why is mitral valve repair preferred to replacement in primary mitral regurgitation?
JapaneseQuestion: 一次性僧帽弁閉鎖不全症で弁置換より弁形成を優先する理由は？
EnglishAnswer: A durable repair preserves the native valve and is preferred whenever technically feasible.
JapaneseAnswer: 耐久性ある形成が可能なら自己弁を温存できるため。

EnglishQuestion: When is transcatheter edge-to-edge repair (TEER) considered for severe mitral regurgitation?
JapaneseQuestion: 重症僧帽弁閉鎖不全症で経カテーテル的edge-to-edge repair（TEER）を検討するのはいつか？
EnglishAnswer: In selected patients with suitable anatomy and symptomatic severe regurgitation who have high surgical risk or are inoperable, after Heart Team assessment.
JapaneseAnswer: 解剖が適し、症候性重症逆流があり、外科リスクが高いまたは手術不能な選択例でHeart Teamが検討する。

EnglishQuestion: Why is TEER not equivalent to surgical repair for every patient with mitral regurgitation?
JapaneseQuestion: TEERを全僧帽弁逆流患者で外科的形成と同列に扱えないのはなぜか？
EnglishAnswer: Its use depends on anatomy, symptoms, and surgical risk and is reserved for selected patients.
JapaneseAnswer: 解剖、症状、外科リスクに依存し、選択例に限られるため。

EnglishQuestion: Which prosthesis-related risks must be considered after mitral valve replacement?
JapaneseQuestion: 僧帽弁置換後に考慮するprosthesis関連リスクは？
EnglishAnswer: Thromboembolism, anticoagulation-related bleeding, and structural valve deterioration, depending on prosthesis type.
JapaneseAnswer: 人工弁の種類に応じた血栓塞栓症、抗凝固関連出血、構造的弁劣化。

EnglishQuestion: What is the treatment flow for mitral stenosis and mitral regurgitation?
JapaneseQuestion: 僧帽弁狭窄症と僧帽弁閉鎖不全症の治療フローは？
EnglishAnswer: For mitral stenosis, control symptoms and atrial fibrillation, perform balloon commissurotomy when severe symptomatic disease has favorable anatomy, and operate when balloon treatment is contraindicated or unsuccessful. For severe mitral regurgitation, manage hemodynamics and atrial fibrillation, prefer durable repair, and replace the valve if repair is impossible.
JapaneseAnswer: 僧帽弁狭窄症では症状と心房細動を管理し、適した症候性重症例にballoon交連切開術を行い、禁忌または不成功なら手術とする。重症僧帽弁閉鎖不全症では循環動態と心房細動を管理し、耐久性ある弁形成を優先し、形成不能なら置換する。

EnglishQuestion: What is the defining pathophysiology of aortic dissection?
JapaneseQuestion: 大動脈解離の病態定義は？
EnglishAnswer: Blood enters the aortic media through an intimal tear, creating a false lumen separated from the true lumen by an intimal flap.
JapaneseAnswer: 内膜裂孔から血液が大動脈中膜へ入り、intimal flapで真腔と隔てられた偽腔を形成する。

EnglishQuestion: Which anatomic feature determines Stanford type A versus type B aortic dissection?
JapaneseQuestion: Stanford A型とB型を分ける解剖学的特徴は？
EnglishAnswer: Any involvement of the ascending aorta defines type A; absence of ascending aortic involvement defines type B.
JapaneseAnswer: 上行大動脈を少しでも含めばA型、含まなければB型。

EnglishQuestion: How do DeBakey types I, II, and III correspond to the extent of aortic dissection?
JapaneseQuestion: DeBakey I・II・III型の解離範囲は？
EnglishAnswer: Type I involves the ascending aorta, arch, and descending aorta; type II involves only the ascending aorta; type III begins in and is confined initially to the descending aorta.
JapaneseAnswer: I型は上行・弓部・下行大動脈、II型は上行大動脈のみ、III型は下行大動脈から始まる。

EnglishQuestion: Where does DeBakey type III aortic dissection usually begin?
JapaneseQuestion: DeBakey III型大動脈解離は通常どこから始まるか？
EnglishAnswer: Distal to the left subclavian artery origin.
JapaneseAnswer: 左鎖骨下動脈分岐より遠位。

EnglishQuestion: Which major conditions predispose to aortic dissection?
JapaneseQuestion: 大動脈解離の主な素因は？
EnglishAnswer: Hypertension, Marfan syndrome, Ehlers-Danlos syndrome and other connective-tissue disorders, atherosclerosis, thoracic trauma, and pregnancy.
JapaneseAnswer: 高血圧、Marfan症候群、Ehlers-Danlos症候群などの結合組織疾患、動脈硬化、胸部外傷、妊娠。

EnglishQuestion: Where is the intimal tear commonly located in aortic dissection?
JapaneseQuestion: 大動脈解離の内膜裂孔はどこに生じやすいか？
EnglishAnswer: In the ascending aorta, often within 10 cm of the aortic valve.
JapaneseAnswer: 大動脈弁から10 cm以内の上行大動脈。

EnglishQuestion: In which directions can an aortic dissection propagate?
JapaneseQuestion: 大動脈解離はどの方向へ進展し得るか？
EnglishAnswer: Retrogradely toward the heart or distally as far as the iliac and femoral arteries.
JapaneseAnswer: 心臓側へ逆行性、または腸骨・大腿動脈まで遠位へ進展し得る。

EnglishQuestion: What happens when an aortic dissection ruptures through the adventitia or into the pericardial space?
JapaneseQuestion: 大動脈解離が外膜または心膜腔へ破裂すると何が起こるか？
EnglishAnswer: Adventitial rupture causes massive hemorrhage; rupture into the pericardium causes hemopericardium and cardiac tamponade.
JapaneseAnswer: 外膜破裂では大量出血、心膜腔への破裂では血性心膜液と心タンポナーデを来す。

EnglishQuestion: How do true aneurysm, pseudoaneurysm, and aortic dissection differ?
JapaneseQuestion: 真性動脈瘤、仮性動脈瘤、大動脈解離の違いは？
EnglishAnswer: A true aneurysm dilates while retaining all three wall layers; a pseudoaneurysm is contained extravascular leakage through a wall defect; a dissection tracks within the media and creates true and false lumina.
JapaneseAnswer: 真性動脈瘤は血管壁3層を保って拡張し、仮性動脈瘤は壁破綻部からの血管外漏出が周囲組織に被包され、解離は中膜内を進んで真腔と偽腔を作る。

EnglishQuestion: What should be assessed systematically on CTA, TEE, or MRA in aortic dissection?
JapaneseQuestion: 大動脈解離のCTA・TEE・MRAで系統的に評価する項目は？
EnglishAnswer: The intimal flap, entry and re-entry sites, true and false lumina, branch-vessel perfusion, coronary involvement, rupture, and pericardial effusion.
JapaneseAnswer: Intimal flap、entry・re-entry、真腔・偽腔、分枝灌流、冠動脈波及、破裂、心嚢液。

EnglishQuestion: Which clinical features should raise suspicion for acute aortic dissection?
JapaneseQuestion: 急性大動脈解離を疑う臨床所見は？
EnglishAnswer: Sudden chest pain, possible back radiation, inter-arm or regional blood pressure and pulse differences, syncope, neurologic deficits, dyspnea, nausea, or weakness.
JapaneseAnswer: 突然の胸痛、背部放散、部位による血圧・脈拍差、失神、神経脱落所見、呼吸困難、悪心、脱力。

EnglishQuestion: Which organ complications can aortic dissection cause?
JapaneseQuestion: 大動脈解離が起こし得る臓器合併症は？
EnglishAnswer: Myocardial infarction, heart failure, acute limb ischemia, neurologic ischemia, renal or visceral malperfusion, hemothorax, and cardiac tamponade.
JapaneseAnswer: 心筋梗塞、心不全、急性下肢虚血、神経虚血、腎・内臓灌流障害、血胸、心タンポナーデ。

EnglishQuestion: What may a chest radiograph show in aortic dissection?
JapaneseQuestion: 大動脈解離の胸部X線でみられ得る所見は？
EnglishAnswer: A widened mediastinum.
JapaneseAnswer: 縦隔拡大。

EnglishQuestion: What is the role of the ECG in suspected aortic dissection?
JapaneseQuestion: 大動脈解離疑いでのECGの役割は？
EnglishAnswer: Assess myocardial ischemia and possible coronary artery involvement; a normal or nonspecific ECG does not exclude dissection.
JapaneseAnswer: 心筋虚血と冠動脈波及を評価する。正常または非特異的ECGでも解離は除外できない。

EnglishQuestion: Which imaging tests can confirm aortic dissection?
JapaneseQuestion: 大動脈解離を確定できる画像検査は？
EnglishAnswer: CT angiography, transesophageal echocardiography, or MR angiography.
JapaneseAnswer: CT angiography、経食道心エコー（TEE）、MR angiography。

EnglishQuestion: What are the immediate stabilization steps in suspected acute aortic dissection?
JapaneseQuestion: 急性大動脈解離疑いで直ちに行う安定化処置は？
EnglishAnswer: Assess ABCs, obtain intravenous access and blood samples, continuously monitor heart rate and blood pressure, and provide analgesia such as morphine.
JapaneseAnswer: ABC評価、静脈路確保と採血、心拍数・血圧の連続監視、morphineなどによる鎮痛。

EnglishQuestion: Why is an intravenous beta blocker given before a vasodilator in acute aortic dissection?
JapaneseQuestion: 急性大動脈解離で血管拡張薬より先に静注beta blockerを投与する理由は？
EnglishAnswer: It first reduces heart rate and left ventricular impulse; giving a vasodilator alone can provoke reflex tachycardia and increase aortic shear stress.
JapaneseAnswer: まず心拍数と左室駆出力を抑えるため。血管拡張薬単独では反射性頻脈により大動脈壁shear stressを増やし得る。

EnglishQuestion: What can replace beta blockade when a true contraindication exists in acute aortic dissection?
JapaneseQuestion: 急性大動脈解離でbeta blockerに真の禁忌がある場合の代替薬は？
EnglishAnswer: A non-dihydropyridine calcium channel blocker may be considered.
JapaneseAnswer: 非dihydropyridine系calcium channel blockerを検討する。

EnglishQuestion: Does chronic obstructive pulmonary disease alone absolutely contraindicate beta blockade in aortic dissection?
JapaneseQuestion: COPDだけで大動脈解離のbeta blockerは絶対禁忌となるか？
EnglishAnswer: No. Avoid it for a true contraindication such as severe active bronchospasm, not for COPD alone.
JapaneseAnswer: ならない。COPDだけで一律回避せず、重症気管支攣縮など真の禁忌で避ける。

EnglishQuestion: How do the definitive treatments of Stanford type A and uncomplicated type B aortic dissection differ?
JapaneseQuestion: Stanford A型と合併症のないB型大動脈解離の根治的治療はどう異なるか？
EnglishAnswer: Type A requires emergency surgical repair plus blood pressure control; uncomplicated type B is treated initially with strict anti-impulse medical therapy.
JapaneseAnswer: A型は降圧と緊急外科修復を行い、合併症のないB型は厳格なanti-impulse薬物療法を基本とする。

EnglishQuestion: What is the diagnostic and treatment flow for suspected acute aortic dissection?
JapaneseQuestion: 急性大動脈解離疑いの診断・治療フローは？
EnglishAnswer: Stabilize ABCs, obtain IV access, monitor, and relieve pain -> begin beta-blocker-centered anti-impulse therapy -> confirm and classify with CTA, TEE, or MRA -> perform emergency surgery for type A or medical therapy for uncomplicated type B while evaluating rupture and malperfusion.
JapaneseAnswer: ABC安定化、静脈路、monitoring、鎮痛→beta blocker中心のanti-impulse療法→CTA・TEE・MRAで確定・分類→A型は緊急手術、合併症のないB型は薬物療法とし、破裂・灌流障害を同時評価する。

EnglishQuestion: What is the purpose of coronary artery bypass grafting (CABG)?
JapaneseQuestion: 冠動脈バイパス術（CABG）の目的は？
EnglishAnswer: To bypass a stenosed or occluded coronary segment with a vascular graft and deliver oxygenated blood to ischemic myocardium.
JapaneseAnswer: 狭窄・閉塞した冠動脈区間を血管graftで迂回し、虚血心筋へ酸素化血を送る。

EnglishQuestion: What degree of left main coronary artery stenosis is a major indication for CABG?
JapaneseQuestion: CABGの主な適応となる左主幹部狭窄度は？
EnglishAnswer: Severe stenosis greater than 50%.
JapaneseAnswer: 50%を超える高度狭窄。

EnglishQuestion: Which multivessel coronary pattern supports CABG?
JapaneseQuestion: CABGを支持する多枝冠動脈病変は？
EnglishAnswer: Two- or three-vessel disease with significant LAD stenosis greater than 70%.
JapaneseAnswer: LADの70%超の有意狭窄を伴う2枝または3枝病変。

EnglishQuestion: In which acute coronary settings may CABG be required?
JapaneseQuestion: 急性冠症候群のどの状況でCABGが必要になり得るか？
EnglishAnswer: Acute complications after primary PCI, mechanical complications of acute myocardial infarction, or primary reperfusion when PCI and fibrinolysis are unsuitable.
JapaneseAnswer: Primary PCI後の急性合併症、急性心筋梗塞の機械的合併症、PCI・線溶療法が不適な場合のprimary reperfusion。

EnglishQuestion: Which patient factors can favor CABG in complex coronary disease?
JapaneseQuestion: 複雑冠動脈病変でCABGを支持する患者要因は？
EnglishAnswer: High-risk anatomy or clinical status, severe ventricular dysfunction, and diabetes mellitus.
JapaneseAnswer: 高リスク病変・臨床状態、重度心室機能障害、糖尿病。

EnglishQuestion: Where is the distal end of a bypass graft attached relative to a coronary stenosis?
JapaneseQuestion: 冠動脈狭窄に対してbypass graftの遠位端をどこへ吻合するか？
EnglishAnswer: To the target coronary artery distal to the stenosis.
JapaneseAnswer: 狭窄より末梢側の標的冠動脈。

EnglishQuestion: Which arterial conduits can be used for CABG?
JapaneseQuestion: CABGに使用できる動脈graftは？
EnglishAnswer: The internal thoracic artery, radial artery, and gastroepiploic artery.
JapaneseAnswer: 内胸動脈、橈骨動脈、胃大網動脈。

EnglishQuestion: Which venous conduit is commonly used for CABG?
JapaneseQuestion: CABGで一般的に用いる静脈graftは？
EnglishAnswer: The great saphenous vein.
JapaneseAnswer: 大伏在静脈。

EnglishQuestion: How is the left internal thoracic artery usually used in CABG?
JapaneseQuestion: CABGで左内胸動脈は通常どのように用いるか？
EnglishAnswer: As an in-situ graft that retains its proximal connection to the subclavian artery and is anastomosed distally to the LAD.
JapaneseAnswer: 鎖骨下動脈との近位接続を保つin-situ graftとして、遠位端をLADへ吻合する。

EnglishQuestion: How is a free saphenous vein graft connected in CABG?
JapaneseQuestion: CABGでfree saphenous vein graftをどう接続するか？
EnglishAnswer: Its proximal end is attached to the ascending aorta and its distal end to the target coronary artery beyond the stenosis.
JapaneseAnswer: 近位端を上行大動脈、遠位端を狭窄より末梢の標的冠動脈へ吻合する。

EnglishQuestion: Why is it incorrect to say that every CABG graft has one end attached to the aorta?
JapaneseQuestion: すべてのCABG graftの一端が大動脈に吻合されるとは限らないのはなぜか？
EnglishAnswer: An in-situ internal thoracic artery graft preserves its native proximal connection to the subclavian artery.
JapaneseAnswer: In-situ内胸動脈graftは鎖骨下動脈との生来の近位接続を温存するため。

EnglishQuestion: How do off-pump and on-pump CABG differ?
JapaneseQuestion: Off-pump CABGとon-pump CABGの違いは？
EnglishAnswer: Off-pump CABG maintains the native heartbeat and uses a stabilizer; on-pump CABG uses cardiopulmonary bypass, an aortic cross-clamp, and cardioplegia to arrest the heart temporarily.
JapaneseAnswer: Off-pumpは自己心拍を維持してstabilizerを使い、on-pumpは人工心肺、aortic cross-clamp、cardioplegiaで一時的に心停止させる。

EnglishQuestion: What is the operative sequence of CABG?
JapaneseQuestion: CABGの手術手順は？
EnglishAnswer: Median sternotomy -> graft harvest -> heparinization -> off-pump stabilization or on-pump cardiopulmonary bypass with cardioplegia -> distal anastomosis -> proximal anastomosis for free grafts -> restore cardiac activity -> reverse heparin with protamine -> sternal closure and ICU care.
JapaneseAnswer: 胸骨正中切開→graft採取→heparin投与→off-pump固定またはon-pump人工心肺・cardioplegia→遠位吻合→free graftの近位吻合→心拍再開→protamineで中和→胸骨閉鎖・ICU管理。

EnglishQuestion: What is the purpose of heparin during CABG and protamine afterward?
JapaneseQuestion: CABG中のheparinと術後protamineの目的は？
EnglishAnswer: Heparin prevents clotting during grafting and cardiopulmonary bypass; protamine neutralizes heparin before closure.
JapaneseAnswer: Heparinはgraft吻合・人工心肺中の凝固を防ぎ、protamineは閉創前にheparinを中和する。

EnglishQuestion: What mechanisms can cause perioperative myocardial infarction after CABG?
JapaneseQuestion: CABG後の周術期心筋梗塞の機序は？
EnglishAnswer: Low coronary perfusion and early graft occlusion or failure.
JapaneseAnswer: 冠灌流低下、早期graft閉塞・不全。

EnglishQuestion: What mechanisms can cause stroke after CABG?
JapaneseQuestion: CABG後strokeの主な機序は？
EnglishAnswer: Embolization from aortic manipulation and cerebral hypoperfusion.
JapaneseAnswer: 大動脈操作による塞栓と脳低灌流。

EnglishQuestion: What is postperfusion syndrome after CABG?
JapaneseQuestion: CABG後のpostperfusion syndromeとは？
EnglishAnswer: Transient neurocognitive dysfunction associated with cardiopulmonary bypass, sometimes called pumphead.
JapaneseAnswer: 人工心肺に関連する一過性神経認知障害で、pumpheadとも呼ばれる。

EnglishQuestion: Why can postoperative bleeding occur after CABG?
JapaneseQuestion: CABG後に出血が起こる理由は？
EnglishAnswer: Heparin exposure, hemodilution, platelet dysfunction, coagulopathy, and hypothermia.
JapaneseAnswer: Heparin曝露、血液希釈、血小板機能障害、凝固障害、低体温。

EnglishQuestion: What causes the systemic inflammatory response associated with on-pump CABG?
JapaneseQuestion: On-pump CABGに伴う全身炎症反応の原因は？
EnglishAnswer: Contact between blood and the artificial surfaces of the cardiopulmonary bypass circuit.
JapaneseAnswer: 血液と人工心肺回路の人工表面との接触。

EnglishQuestion: Which major complications require monitoring after CABG?
JapaneseQuestion: CABG後に監視すべき主な合併症は？
EnglishAnswer: Myocardial infarction, stroke, bleeding, transient neurocognitive dysfunction, and systemic inflammation with possible organ injury.
JapaneseAnswer: 心筋梗塞、stroke、出血、一過性神経認知障害、臓器障害へ進展し得る全身炎症。

EnglishQuestion: What is the purpose of mechanical circulatory support (MCS) in advanced heart failure?
JapaneseQuestion: 進行心不全における機械的循環補助（MCS）の目的は？
EnglishAnswer: To replace or support cardiac pump function as a bridge to recovery, decision, another device, or transplantation, or as permanent destination therapy.
JapaneseAnswer: 回復、治療方針決定、次のdevice、移植への橋渡し、または恒久的destination therapyとして心臓pump機能を代替・補助する。

EnglishQuestion: What does NYHA class IV heart failure mean?
JapaneseQuestion: NYHA IV度心不全とは？
EnglishAnswer: Symptoms are present at rest and the patient cannot perform physical activity without discomfort.
JapaneseAnswer: 安静時にも症状があり、身体活動を行えない状態。

EnglishQuestion: Which diseases can cause end-stage chronic heart failure requiring MCS assessment?
JapaneseQuestion: MCS評価を要する末期慢性心不全の原因疾患は？
EnglishAnswer: Ischemic dilated cardiomyopathy, hypertrophic cardiomyopathy, and congenital heart disease, among others.
JapaneseAnswer: 虚血性拡張型心筋症、肥大型心筋症、先天性心疾患など。

EnglishQuestion: What is bridge-to-recovery mechanical support?
JapaneseQuestion: Bridge to recoveryとしての機械的循環補助とは？
EnglishAnswer: Short-term support used when native cardiac recovery is expected, such as after acute myocardial infarction, myocarditis, postcardiotomy syndrome, or primary graft failure.
JapaneseAnswer: 急性心筋梗塞、心筋炎、postcardiotomy syndrome、primary graft failureなど、自己心回復が期待される場合の短期補助。

EnglishQuestion: What is bridge-to-decision or bridge-to-bridge mechanical support?
JapaneseQuestion: Bridge to decisionまたはbridge to bridgeとしての機械的循環補助とは？
EnglishAnswer: Short-term stabilization of cardiogenic shock or impending multiorgan failure while candidacy and the next durable strategy are determined.
JapaneseAnswer: 心原性shockまたは切迫多臓器不全を短期安定化し、適格性と次の長期戦略を決めるための補助。

EnglishQuestion: What is bridge-to-transplant or bridge-to-candidacy mechanical support?
JapaneseQuestion: Bridge to transplantまたはbridge to candidacyとしての機械的循環補助とは？
EnglishAnswer: Long-term support while awaiting transplantation or while attempting to achieve transplant eligibility.
JapaneseAnswer: 移植待機中、または移植適格性を獲得するまでの長期補助。

EnglishQuestion: What is destination therapy with a ventricular assist device?
JapaneseQuestion: 補助人工心臓によるdestination therapyとは？
EnglishAnswer: Long-term permanent support for a patient who is not eligible for heart transplantation.
JapaneseAnswer: 心移植不適格患者に対する恒久的な長期補助。

EnglishQuestion: What treatment should be optimized before proceeding to long-term MCS?
JapaneseQuestion: 長期MCSへ進む前に最適化すべき治療は？
EnglishAnswer: Guideline-directed medical therapy at the maximum tolerated doses, with CRT and ICD considered when indicated.
JapaneseAnswer: 最大耐容量のguideline-directed medical therapyを導入し、適応があればCRT・ICDも検討する。

EnglishQuestion: Which factors should be evaluated when considering long-term MCS?
JapaneseQuestion: 長期MCSを検討するときの評価項目は？
EnglishAnswer: Persistent advanced symptoms, recurrent admissions, hypoperfusion or organ injury, transplant eligibility, right ventricular function, infection and bleeding risks, and the patient's goals.
JapaneseAnswer: 進行性症状、反復入院、低灌流・臓器障害、移植適格性、右室機能、感染・出血リスク、患者目標。

EnglishQuestion: How does intra-aortic balloon pumping (IABP) improve hemodynamics?
JapaneseQuestion: 大動脈内バルーンパンピング（IABP）はどのように循環動態を改善するか？
EnglishAnswer: The balloon inflates during diastole to augment coronary perfusion and deflates just before systole to reduce left ventricular afterload.
JapaneseAnswer: 拡張期にballoonを膨張させて冠灌流を増やし、収縮期直前に収縮させて左室後負荷を軽減する。

EnglishQuestion: When should an IABP inflate and deflate relative to the arterial pressure waveform?
JapaneseQuestion: 動脈圧波形に対してIABPはいつinflation・deflationするか？
EnglishAnswer: Inflate immediately after the dicrotic notch and deflate just before the next systole.
JapaneseAnswer: Dicrotic notch直後にinflationし、次の収縮期直前にdeflationする。

EnglishQuestion: What pressure-waveform effects indicate correctly timed IABP support?
JapaneseQuestion: 適切なIABP timingを示す圧波形変化は？
EnglishAnswer: Diastolic augmentation after inflation and reduced assisted end-diastolic and systolic pressures after deflation.
JapaneseAnswer: Inflation後のdiastolic augmentationと、deflation後のassisted end-diastolic pressure・収縮期圧低下。

EnglishQuestion: What can result from incorrect IABP timing?
JapaneseQuestion: IABP timing不良で何が起こるか？
EnglishAnswer: Loss of circulatory benefit and, in some timing errors, an increase in afterload.
JapaneseAnswer: 補助効果の低下と、timingによっては後負荷増加。

EnglishQuestion: What is the clinical role of IABP?
JapaneseQuestion: IABPの臨床的役割は？
EnglishAnswer: Temporary support in selected acute low-output or cardiogenic shock states as a bridge to recovery or definitive treatment.
JapaneseAnswer: 選択された急性低心拍出量・心原性shockで、回復または根治治療まで一時的に補助する。

EnglishQuestion: What are important limitations and complications of IABP?
JapaneseQuestion: IABPの重要な限界と合併症は？
EnglishAnswer: It does not directly unload left ventricular volume and can cause limb ischemia and bleeding.
JapaneseAnswer: 左室容量負荷を直接減らさず、下肢虚血や出血を起こし得る。

EnglishQuestion: What are major contraindications to IABP?
JapaneseQuestion: IABPの主な禁忌は？
EnglishAnswer: Severe aortic regurgitation and aortic dissection.
JapaneseAnswer: 高度大動脈弁閉鎖不全症と大動脈解離。

EnglishQuestion: Is full systemic anticoagulation mandatory for every patient receiving IABP?
JapaneseQuestion: IABP使用中は全例で完全抗凝固が必須か？
EnglishAnswer: No. Anticoagulation is individualized according to bleeding risk, thrombosis risk, and support duration.
JapaneseAnswer: 必須ではなく、出血リスク、血栓リスク、使用期間に応じて個別化する。

EnglishQuestion: What is the blood-flow pathway through peripheral VA-ECMO?
JapaneseQuestion: 末梢VA-ECMOの血流経路は？
EnglishAnswer: Vein -> drainage cannula -> pump -> membrane oxygenator for carbon dioxide removal and oxygenation -> arterial return cannula.
JapaneseAnswer: 静脈→脱血cannula→pump→CO2除去・酸素化を行う膜型人工肺→動脈送血cannula。

EnglishQuestion: What support does VA-ECMO provide in cardiogenic shock?
JapaneseQuestion: 心原性shockでVA-ECMOが提供する補助は？
EnglishAnswer: Both systemic circulatory support and blood oxygenation.
JapaneseAnswer: 全身循環補助と血液酸素化の両方。

EnglishQuestion: Why is there no fixed maximum duration such as one week for VA-ECMO?
JapaneseQuestion: VA-ECMOに1週間などの固定上限がないのはなぜか？
EnglishAnswer: Duration depends on recovery potential, bridge strategy, circuit and oxygenator function, and evolving complications, which require repeated reassessment.
JapaneseAnswer: 回復可能性、bridge strategy、回路・人工肺機能、合併症を反復評価して個別に決めるため。

EnglishQuestion: Which complications require monitoring during VA-ECMO?
JapaneseQuestion: VA-ECMO中に監視すべき合併症は？
EnglishAnswer: Limb ischemia, bleeding and coagulation abnormalities, hemolysis, thromboembolism, and infection or sepsis.
JapaneseAnswer: 下肢虚血、出血・凝固異常、溶血、血栓塞栓、感染・sepsis。

EnglishQuestion: What is the purpose of a distal perfusion cannula during peripheral VA-ECMO?
JapaneseQuestion: 末梢VA-ECMOでdistal perfusion cannulaを用いる目的は？
EnglishAnswer: To reduce the risk of ipsilateral lower-limb ischemia.
JapaneseAnswer: 同側下肢虚血のリスクを減らすため。

EnglishQuestion: How does a CentriMag circuit differ from VA-ECMO?
JapaneseQuestion: CentriMag回路とVA-ECMOの違いは？
EnglishAnswer: CentriMag is an extracorporeal centrifugal pump without an intrinsic oxygenator, so it provides pump support but not gas exchange unless an oxygenator is added to the circuit.
JapaneseAnswer: CentriMagはdevice単体に人工肺を持たない体外遠心pumpで、人工肺を回路に追加しない限りgas exchangeは行わない。

EnglishQuestion: How can CentriMag be configured for temporary circulatory support?
JapaneseQuestion: CentriMagは短期循環補助としてどう構成できるか？
EnglishAnswer: It can be surgically connected as an LVAD, RVAD, or BiVAD as a bridge to recovery, decision, another device, or transplantation.
JapaneseAnswer: 外科的に接続し、LVAD、RVAD、BiVADとして回復、方針決定、次のdevice、移植への橋渡しに用いる。

EnglishQuestion: How do Berlin Heart EXCOR, HeartMate II, and HeartMate 3 differ?
JapaneseQuestion: Berlin Heart EXCOR、HeartMate II、HeartMate 3の違いは？
EnglishAnswer: EXCOR is an extracorporeal pneumatic pulsatile LVAD, RVAD, or BiVAD suitable for children and requiring intensive anticoagulation; HeartMate II is a second-generation axial continuous-flow LVAD; HeartMate 3 is a centrifugal continuous-flow LVAD with less pump thrombosis than HeartMate II but persistent bleeding, infection, stroke, and right-heart-failure risks.
JapaneseAnswer: EXCORは小児にも使える体外式空気駆動拍動型LVAD・RVAD・BiVADで強力な抗凝固を要する。HeartMate IIは第2世代軸流continuous-flow LVAD、HeartMate 3は遠心continuous-flow LVADでpump thrombosisは少ないが出血、感染、stroke、右心不全リスクは残る。

EnglishQuestion: What is the blood-flow pathway through an implantable LVAD?
JapaneseQuestion: 植込み型LVADの血流経路は？
EnglishAnswer: Left ventricular apex -> implantable pump -> outflow graft -> ascending aorta.
JapaneseAnswer: 左室心尖部→植込みpump→outflow graft→上行大動脈。

EnglishQuestion: How do VA-ECMO and an isolated ventricular assist device differ functionally?
JapaneseQuestion: VA-ECMOと単独VADの機能的な違いは？
EnglishAnswer: VA-ECMO supports both gas exchange and circulation; an isolated VAD primarily replaces ventricular pump function.
JapaneseAnswer: VA-ECMOはgas exchangeと循環を同時に補助し、単独VADは主に心室pump機能を補う。

EnglishQuestion: What is the device-selection flow for end-stage heart failure or cardiogenic shock?
JapaneseQuestion: 末期心不全・心原性shockにおけるdevice選択フローは？
EnglishAnswer: Determine whether short- or long-term support is needed -> use IABP, VA-ECMO, or CentriMag for short-term recovery or decision bridging -> use EXCOR or HeartMate for transplant bridging or destination therapy when long-term support is required.
JapaneseAnswer: 短期か長期かを判断→短期はIABP・VA-ECMO・CentriMagで回復・方針決定へ橋渡し→長期はEXCOR・HeartMateで移植への橋渡しまたはdestination therapyとする。

EnglishQuestion: Which self-care tasks are essential after discharge with a durable LVAD?
JapaneseQuestion: 長期LVAD装着後の退院後self-careは？
EnglishAnswer: Charge and exchange batteries, perform sterile driveline exit-site care and fixation, protect the system during bathing, follow anticoagulation and INR, record weight, temperature, medication dose, INR, and device parameters, and attend regular follow-up.
JapaneseAnswer: Battery充電・交換、driveline出口部の無菌処置と固定、入浴時保護、抗凝固・INR管理、体重・体温・薬剤量・INR・device parameterの記録、定期follow-up。

EnglishQuestion: What major complication categories should be considered after acute myocardial infarction?
JapaneseQuestion: 急性心筋梗塞後に警戒する主な合併症カテゴリーは？
EnglishAnswer: Electrical instability, pump failure, mechanical tissue rupture, inflammation, and thrombosis or embolism.
JapaneseAnswer: 電気的不安定性、pump failure、心筋組織の機械的破綻、炎症、血栓・塞栓。

EnglishQuestion: How are ventricular fibrillation and pulseless ventricular tachycardia treated after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の心室細動・無脈性心室頻拍はどう治療するか？
EnglishAnswer: Start CPR and deliver immediate unsynchronized defibrillation while correcting reversible causes such as recurrent ischemia, hypoxia, and electrolyte abnormalities.
JapaneseAnswer: CPRを開始して直ちに非同期defibrillationを行い、再虚血、低酸素、電解質異常などの可逆的原因を同時に治療する。

EnglishQuestion: How is ventricular tachycardia with a pulse treated after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の脈あり心室頻拍はどう治療するか？
EnglishAnswer: Perform synchronized cardioversion if hemodynamically unstable; if stable, use close monitoring, an antiarrhythmic drug, and correction of ischemia or electrolyte abnormalities.
JapaneseAnswer: 血行動態不安定なら同期下cardioversion、安定なら厳重monitoring下で抗不整脈薬と虚血・電解質異常の治療を行う。

EnglishQuestion: How is Mobitz type I second-degree AV block managed after myocardial infarction?
JapaneseQuestion: 心筋梗塞後のMobitz I型2度AV blockはどう管理するか？
EnglishAnswer: Observe if asymptomatic and hemodynamically stable; consider atropine for symptomatic bradycardia.
JapaneseAnswer: 無症候で血行動態が安定していれば監視し、症候性徐脈ではatropineを検討する。

EnglishQuestion: How are Mobitz type II, high-grade, and complete AV block managed after myocardial infarction?
JapaneseQuestion: 心筋梗塞後のMobitz II型、高度、完全AV blockはどう管理するか？
EnglishAnswer: Prepare transcutaneous pacing and use transvenous pacing when required; atropine is often ineffective.
JapaneseAnswer: 経皮pacingを準備し、必要に応じ経静脈pacingを行う。Atropineは無効なことが多い。

EnglishQuestion: How is atrial fibrillation managed after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の心房細動はどう管理するか？
EnglishAnswer: Use rate control, usually with a beta blocker; consider amiodarone or electrical cardioversion for rhythm control and anticoagulate when indicated.
JapaneseAnswer: 通常beta blockerでrate controlし、rhythm controlにはamiodaroneまたは電気的cardioversionを検討し、適応に応じ抗凝固する。

EnglishQuestion: What is the immediate treatment for hemodynamically unstable atrial fibrillation after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の血行動態不安定な心房細動の直ちに行う治療は？
EnglishAnswer: Synchronized cardioversion before prolonged drug selection.
JapaneseAnswer: 薬剤選択に先立つ同期下cardioversion。

EnglishQuestion: Why should class Ic antiarrhythmic drugs such as propafenone be avoided after myocardial infarction?
JapaneseQuestion: 心筋梗塞後にpropafenoneなどClass Ic抗不整脈薬を避ける理由は？
EnglishAnswer: They are unsafe in prior myocardial infarction, significant structural heart disease, or ventricular scar because they can promote malignant ventricular arrhythmia.
JapaneseAnswer: 心筋梗塞既往、有意な構造的心疾患、心室瘢痕では致死性心室性不整脈を促進し得るため。

EnglishQuestion: Does VT or VF within 48 hours after reperfusion automatically indicate an ICD?
JapaneseQuestion: 再灌流後48時間以内のVT・VFは自動的にICD適応となるか？
EnglishAnswer: No. When caused by reversible acute ischemia or another reversible factor, it usually does not by itself justify an ICD.
JapaneseAnswer: ならない。急性虚血など可逆的原因による場合、それだけでは通常ICD適応としない。

EnglishQuestion: When should an ICD be evaluated for secondary prevention after myocardial infarction?
JapaneseQuestion: 心筋梗塞後のsecondary preventionとしてICDを評価するのはいつか？
EnglishAnswer: For sustained VT or VF occurring more than 48 hours after infarction when no reversible cause is present.
JapaneseAnswer: 梗塞48時間超で生じた持続性VT・VFに可逆的原因がない場合。

EnglishQuestion: When is primary-prevention ICD eligibility generally assessed after myocardial infarction and revascularization?
JapaneseQuestion: 心筋梗塞・血行再建後のprimary prevention ICD適応は原則いつ評価するか？
EnglishAnswer: After adequate treatment and reassessment of LV function, generally at least 40 days after myocardial infarction and at least 90 days after revascularization.
JapaneseAnswer: 十分な治療後に左室機能を再評価し、原則MI後40日以上かつ血行再建後90日以上経過してから判断する。

EnglishQuestion: How is pulmonary congestion from post-MI ventricular failure treated?
JapaneseQuestion: 心筋梗塞後の心室不全による肺うっ血はどう治療するか？
EnglishAnswer: Use a loop diuretic; consider a nitrate for pulmonary edema when blood pressure is maintained.
JapaneseAnswer: Loop diureticを用い、血圧が保たれた肺水腫ではnitrateを検討する。

EnglishQuestion: When should prognostic heart-failure drugs be introduced after myocardial infarction?
JapaneseQuestion: 心筋梗塞後に予後改善心不全薬をいつ導入するか？
EnglishAnswer: After hemodynamic stabilization, with renal function and electrolytes checked, introduce agents such as an ACE inhibitor and mineralocorticoid receptor antagonist when indicated.
JapaneseAnswer: 血行動態安定化後、腎機能と電解質を確認し、適応に応じACE阻害薬やmineralocorticoid receptor antagonistを導入する。

EnglishQuestion: Which findings suggest cardiogenic shock after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の心原性shockを示唆する所見は？
EnglishAnswer: Hypotension with end-organ hypoperfusion such as oliguria, altered consciousness, and cool extremities.
JapaneseAnswer: 低血圧に乏尿、意識障害、四肢冷感などの終末臓器低灌流を伴う。

EnglishQuestion: What is the central treatment for cardiogenic shock caused by acute myocardial infarction?
JapaneseQuestion: 急性心筋梗塞による心原性shock治療の中心は？
EnglishAnswer: Early revascularization of the culprit lesion plus identification and treatment of the shock mechanism.
JapaneseAnswer: Culprit lesionの早期血行再建とshock原因の検索・治療。

EnglishQuestion: Which vasopressor is generally favored in marked hypotension from post-MI cardiogenic shock?
JapaneseQuestion: 心筋梗塞後心原性shockの著明な低血圧で一般に優先するvasopressorは？
EnglishAnswer: Norepinephrine.
JapaneseAnswer: 第一選択はnorepinephrine。

EnglishQuestion: When may dobutamine be considered in post-MI cardiogenic shock?
JapaneseQuestion: 心筋梗塞後心原性shockでdobutamineを検討するのはいつか？
EnglishAnswer: When low cardiac output persists, individualized according to blood pressure and arrhythmia risk; it should not be given routinely to every patient.
JapaneseAnswer: 低心拍出が持続するとき、血圧と不整脈リスクを踏まえて個別に検討し、全例には一律投与しない。

EnglishQuestion: Is routine IABP recommended for cardiogenic shock after acute myocardial infarction?
JapaneseQuestion: 急性心筋梗塞後の心原性shockにroutine IABPは推奨されるか？
EnglishAnswer: No. Routine use has not shown a survival benefit.
JapaneseAnswer: 推奨されない。Routine使用は生存利益を示していない。

EnglishQuestion: When may temporary mechanical circulatory support be considered in post-MI shock?
JapaneseQuestion: 心筋梗塞後shockで一時的機械的循環補助を検討するのはいつか？
EnglishAnswer: When circulatory failure persists despite medical therapy and early reperfusion or when a mechanical complication is present, after shock-team assessment of reversibility and risk.
JapaneseAnswer: 薬物治療と早期再灌流でも循環不全が続く場合、または機械的合併症がある場合に、shock teamが回復可能性とリスクを評価して検討する。

EnglishQuestion: What are the three classic myocardial rupture complications after transmural infarction?
JapaneseQuestion: 貫壁性心筋梗塞後の典型的な3つの破裂合併症は？
EnglishAnswer: Papillary muscle rupture, ventricular septal rupture, and left ventricular free-wall rupture.
JapaneseAnswer: 乳頭筋断裂、心室中隔穿孔、左室自由壁破裂。

EnglishQuestion: What does papillary muscle rupture cause after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の乳頭筋断裂は何を起こすか？
EnglishAnswer: Acute severe mitral regurgitation with sudden pulmonary edema and hemodynamic deterioration.
JapaneseAnswer: 急性重症僧帽弁逆流による突然の肺水腫と循環悪化。

EnglishQuestion: What does ventricular septal rupture cause after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の心室中隔穿孔は何を起こすか？
EnglishAnswer: An acute left-to-right shunt, often with a new systolic murmur and palpable thrill.
JapaneseAnswer: 急性左→右shuntで、新規収縮期雑音とthrillを伴うことが多い。

EnglishQuestion: What does left ventricular free-wall rupture cause after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の左室自由壁破裂は何を起こすか？
EnglishAnswer: Hemopericardium, cardiac tamponade, and abrupt loss of blood pressure.
JapaneseAnswer: 血性心膜液、心タンポナーデ、急激な血圧消失。

EnglishQuestion: What is the characteristic presentation of right ventricular infarction?
JapaneseQuestion: 右室梗塞の特徴的な臨床像は？
EnglishAnswer: Inferior MI with hypotension, elevated jugular venous pressure, and relatively clear lungs; evaluate with right-sided leads V3R-V4R and echocardiography.
JapaneseAnswer: 下壁梗塞に低血圧、頸静脈怒張、肺うっ血に乏しい所見を伴い、右側胸部誘導V3R-V4Rと心エコーで評価する。

EnglishQuestion: Which treatments can worsen right ventricular infarction by reducing preload excessively?
JapaneseQuestion: 右室梗塞で前負荷を過度に低下させ悪化させ得る治療は？
EnglishAnswer: Nitrates and excessive diuresis.
JapaneseAnswer: Nitrateと過度の利尿。

EnglishQuestion: How do a left ventricular true aneurysm and pseudoaneurysm differ after myocardial infarction?
JapaneseQuestion: 心筋梗塞後の左室真性瘤と仮性瘤の違いは？
EnglishAnswer: A true aneurysm is a broad-based bulge composed of scarred infarcted wall and has lower rupture risk; a pseudoaneurysm is a contained free-wall rupture connected by a narrow neck and has high rerupture risk.
JapaneseAnswer: 真性瘤は瘢痕化した梗塞壁による広基性膨隆で破裂リスクが低い。仮性瘤は狭いneckで左室と交通する被包化自由壁破裂で再破裂リスクが高い。

EnglishQuestion: How are anticoagulation and surgery selected for a post-MI left ventricular true aneurysm?
JapaneseQuestion: 心筋梗塞後左室真性瘤で抗凝固と手術をどう選択するか？
EnglishAnswer: Anticoagulate confirmed LV thrombus or selected high-embolism-risk cases; consider surgery only for refractory heart failure, intractable ventricular arrhythmia, or recurrent embolism.
JapaneseAnswer: 確認された左室血栓または塞栓高リスク選択例で抗凝固し、薬物抵抗性心不全、難治性心室性不整脈、反復塞栓でのみ手術を検討する。

EnglishQuestion: How are early post-MI pericarditis and Dressler syndrome distinguished by timing?
JapaneseQuestion: 早期梗塞後心膜炎とDressler症候群を発症時期でどう区別するか？
EnglishAnswer: Early post-MI pericarditis occurs about 1-3 days after infarction; Dressler syndrome occurs several weeks later.
JapaneseAnswer: 早期梗塞後心膜炎はMI後1～3日、Dressler症候群は数週後に発症する。

EnglishQuestion: What findings support post-MI pericarditis, and which anti-inflammatory drug is preferred?
JapaneseQuestion: 梗塞後心膜炎を支持する所見と優先する抗炎症薬は？
EnglishAnswer: Chest pain, a pericardial friction rub, diffuse ST elevation, and PR depression support the diagnosis; use aspirin when anti-inflammatory treatment is needed and consider colchicine according to symptoms and recurrence risk.
JapaneseAnswer: 胸痛、心膜摩擦音、びまん性ST上昇、PR低下から診断し、抗炎症治療が必要ならaspirinを優先し、症状・再発リスクに応じcolchicineを検討する。

EnglishQuestion: Why should non-aspirin NSAIDs be avoided in post-MI pericarditis?
JapaneseQuestion: 梗塞後心膜炎でaspirin以外のNSAIDを避ける理由は？
EnglishAnswer: They may increase reinfarction risk and impair myocardial healing, potentially increasing rupture risk.
JapaneseAnswer: 再梗塞リスクを高め、心筋治癒を妨げて破裂リスクを増やし得るため。

EnglishQuestion: How does vasculitis injure organs?
JapaneseQuestion: 血管炎はどのように臓器を障害するか？
EnglishAnswer: Vessel-wall inflammation causes luminal narrowing or thrombosis and wall weakening or aneurysm, leading to ischemia, infarction, rupture, or hemorrhage.
JapaneseAnswer: 血管壁炎症が内腔狭窄・血栓と壁脆弱化・動脈瘤を生じ、虚血、梗塞、破裂、出血を起こす。

EnglishQuestion: How do infectious and noninfectious vasculitis differ mechanistically?
JapaneseQuestion: 感染性血管炎と非感染性血管炎の機序の違いは？
EnglishAnswer: In infectious vasculitis, bacteria or fungi directly invade the arterial wall; noninfectious vasculitis is immune mediated through mechanisms such as immune complexes, ANCA, anti-endothelial antibodies, or cellular immunity.
JapaneseAnswer: 感染性では細菌・真菌が動脈壁へ直接侵入し、非感染性では免疫複合体、ANCA、抗内皮抗体、細胞性免疫などが関与する。

EnglishQuestion: Which vascular complications can direct microbial invasion cause in infectious vasculitis?
JapaneseQuestion: 感染性血管炎の直接的微生物侵入が起こす血管合併症は？
EnglishAnswer: Mycotic aneurysm, thrombosis, and infarction due to weakening of the arterial wall.
JapaneseAnswer: 動脈壁脆弱化による感染性動脈瘤、血栓、梗塞。

EnglishQuestion: What is the typical patient profile and organ pattern of giant cell arteritis?
JapaneseQuestion: 巨細胞性動脈炎の典型的患者像と罹患血管は？
EnglishAnswer: Age over 50 years with involvement of temporal, ophthalmic, or vertebral arteries.
JapaneseAnswer: 50歳超で、側頭動脈、眼動脈、椎骨動脈を侵す。

EnglishQuestion: Which symptoms suggest giant cell arteritis, and what is the urgent treatment?
JapaneseQuestion: 巨細胞性動脈炎を示唆する症状と緊急治療は？
EnglishAnswer: New headache, visual symptoms or vision loss, jaw claudication, and systemic symptoms; start corticosteroids promptly to prevent blindness.
JapaneseAnswer: 新規頭痛、視覚症状・失明、jaw claudication、全身症状を示し、失明予防のため速やかにcorticosteroidを開始する。

EnglishQuestion: Can a normal temporal artery biopsy exclude giant cell arteritis?
JapaneseQuestion: 側頭動脈生検が正常なら巨細胞性動脈炎を除外できるか？
EnglishAnswer: No. Lesions are segmental, so skip areas can produce a false-negative biopsy.
JapaneseAnswer: 除外できない。病変がsegmentalでskip lesionによる偽陰性があり得る。

EnglishQuestion: What is the typical demographic and vascular pattern of Takayasu arteritis?
JapaneseQuestion: 高安動脈炎の典型的患者像と血管病変は？
EnglishAnswer: Usually a patient younger than 50 years, often in Asia, with granulomatous inflammation of the aortic arch and its branches causing stenosis or occlusion.
JapaneseAnswer: 通常50歳未満でアジアに多く、大動脈弓と分枝の肉芽腫性炎症・線維化が狭窄・閉塞を起こす。

EnglishQuestion: Which findings suggest Takayasu arteritis, and how is it assessed?
JapaneseQuestion: 高安動脈炎を示唆する所見と評価法は？
EnglishAnswer: Reduced upper-extremity pulses, retinal hemorrhage, or neurologic deficits; assess with MRA, CTA, or ultrasonography and treat with corticosteroids.
JapaneseAnswer: 上肢脈拍低下、網膜出血、神経脱落所見を認め、MRA、CTA、超音波で評価しcorticosteroidで治療する。

EnglishQuestion: What is the vascular and serologic pattern of polyarteritis nodosa?
JapaneseQuestion: 結節性多発動脈炎の血管病変と血清学的特徴は？
EnglishAnswer: Segmental necrotizing inflammation of medium arteries, often affecting renal, coronary, hepatic, and mesenteric arteries; it is usually ANCA negative.
JapaneseAnswer: 腎・冠・肝・腸間膜など中動脈の分節性壊死性炎症で、通常ANCA陰性。

EnglishQuestion: Which organ manifestations suggest polyarteritis nodosa?
JapaneseQuestion: 結節性多発動脈炎を示唆する臓器症状は？
EnglishAnswer: Renal failure and hypertension, myocardial infarction, abdominal pain or gastrointestinal bleeding, and skin lesions.
JapaneseAnswer: 腎不全・高血圧、心筋梗塞、腹痛・消化管出血、皮疹。

EnglishQuestion: How is polyarteritis nodosa treated?
JapaneseQuestion: 結節性多発動脈炎はどう治療するか？
EnglishAnswer: Corticosteroids, with cyclophosphamide added according to disease severity.
JapaneseAnswer: Corticosteroidを基本とし、重症度に応じcyclophosphamideを追加する。

EnglishQuestion: What is the characteristic patient group and major vascular risk in Kawasaki disease?
JapaneseQuestion: 川崎病の好発年齢と主要血管リスクは？
EnglishAnswer: Children younger than 5 years, with risk of coronary aneurysm and thrombosis.
JapaneseAnswer: 主に5歳未満で、冠動脈瘤と冠血栓のリスクがある。

EnglishQuestion: What is first-line treatment for Kawasaki disease?
JapaneseQuestion: 川崎病の第一選択治療は？
EnglishAnswer: Intravenous immunoglobulin plus aspirin.
JapaneseAnswer: 静注免疫globulinとaspirin。

EnglishQuestion: What is the key clinical profile and treatment of Buerger disease?
JapaneseQuestion: Buerger病の典型像と治療の中心は？
EnglishAnswer: A young smoker, often under 35 years, with distal ischemia, gangrene, neuropathic pain, or superficial thrombophlebitis; complete smoking cessation is essential.
JapaneseAnswer: 35歳未満の喫煙者に多く、遠位虚血、gangrene、神経性疼痛、表在性血栓性静脈炎を示し、完全禁煙が治療の中心。

EnglishQuestion: What organ pattern and antibody are characteristic of granulomatosis with polyangiitis?
JapaneseQuestion: 多発血管炎性肉芽腫症の臓器パターンと抗体は？
EnglishAnswer: Upper and lower respiratory tract plus renal disease, with PR3-ANCA commonly present.
JapaneseAnswer: 上下気道と腎病変を示し、PR3-ANCAが代表的。

EnglishQuestion: What organ pattern and antibody are characteristic of microscopic polyangiitis?
JapaneseQuestion: 顕微鏡的多発血管炎の臓器パターンと抗体は？
EnglishAnswer: Pulmonary capillaritis with hemoptysis, glomerulonephritis with hematuria, purpura, and possible abdominal pain; MPO-ANCA is characteristic.
JapaneseAnswer: 肺毛細血管炎による喀血、糸球体腎炎による血尿、紫斑、腹痛を示し、MPO-ANCAが代表的。

EnglishQuestion: How are organ-threatening GPA and MPA treated?
JapaneseQuestion: 臓器障害を伴うGPA・MPAはどう治療するか？
EnglishAnswer: Glucocorticoids plus rituximab or cyclophosphamide.
JapaneseAnswer: Glucocorticoidにrituximabまたはcyclophosphamideを併用する。

EnglishQuestion: What triad strongly suggests eosinophilic granulomatosis with polyangiitis?
JapaneseQuestion: 好酸球性多発血管炎性肉芽腫症を強く示唆する3要素は？
EnglishAnswer: Asthma, eosinophilia, and systemic vasculitic involvement such as pulmonary infiltrates, purpura, or mononeuritis multiplex.
JapaneseAnswer: 喘息、好酸球増多、肺浸潤・紫斑・多発単神経炎などの全身血管炎。

EnglishQuestion: Is ANCA always positive in eosinophilic granulomatosis with polyangiitis?
JapaneseQuestion: 好酸球性多発血管炎性肉芽腫症ではANCAは常に陽性か？
EnglishAnswer: No. MPO-ANCA is present in only a subset of patients.
JapaneseAnswer: 常に陽性ではなく、MPO-ANCA陽性は一部のみ。

EnglishQuestion: What clinical tetrad is characteristic of IgA vasculitis?
JapaneseQuestion: IgA血管炎の特徴的な臨床4徴は？
EnglishAnswer: Palpable purpura, abdominal pain, arthralgia, and renal involvement with hematuria.
JapaneseAnswer: 触知可能な紫斑、腹痛、関節痛、血尿を伴う腎病変。

EnglishQuestion: What is the typical presentation and diagnostic test for cutaneous leukocytoclastic vasculitis?
JapaneseQuestion: 皮膚白血球破砕性血管炎の典型像と診断検査は？
EnglishAnswer: Lower-extremity-predominant palpable purpura; skin biopsy demonstrates small-vessel vasculitis, after which drugs, infection, and systemic disease should be sought.
JapaneseAnswer: 下肢優位の触知可能な紫斑を示し、皮膚生検で小血管炎を確認後、薬剤、感染、全身疾患を検索する。

EnglishQuestion: What is the general diagnostic sequence for suspected vasculitis?
JapaneseQuestion: 血管炎疑いの一般的診断フローは？
EnglishAnswer: Exclude infection -> identify vessel-size and organ pattern -> obtain vascular imaging and targeted antibodies -> confirm with biopsy when appropriate -> treat according to cause and organ severity.
JapaneseAnswer: 感染を除外→血管径と臓器パターンを同定→血管画像と標的抗体を評価→適応時に生検で確認→原因と臓器重症度に応じ治療する。

EnglishQuestion: Which ischemic syndromes suggest carotid or vertebral arterial disease?
JapaneseQuestion: 頸動脈・椎骨動脈疾患を示唆する虚血症候群は？
EnglishAnswer: Stroke, transient ischemic attack, and acute monocular vision loss.
JapaneseAnswer: Stroke、一過性脳虚血発作、急性単眼視力喪失。

EnglishQuestion: Which symptoms suggest upper-extremity arterial disease?
JapaneseQuestion: 上肢動脈疾患を示唆する症状は？
EnglishAnswer: Subclavian steal, exertional arm pain, digital symptoms, or acute upper-limb ischemia.
JapaneseAnswer: Subclavian steal、労作時上肢痛、手指症状、急性上肢虚血。

EnglishQuestion: Which clinical syndromes suggest mesenteric, renal, and lower-extremity arterial disease?
JapaneseQuestion: 腸間膜・腎・下肢動脈疾患を示唆する臨床像は？
EnglishAnswer: Mesenteric disease causes acute or chronic mesenteric ischemia; renal disease causes hypertension or renal failure; lower-extremity disease causes claudication, chronic limb-threatening ischemia, or acute limb ischemia.
JapaneseAnswer: 腸間膜病変は急性・慢性腸間膜虚血、腎動脈病変は高血圧・腎不全、下肢病変はclaudication、慢性肢切迫虚血、急性下肢虚血を起こす。

EnglishQuestion: What should be included in the bedside vascular examination for suspected arterial disease?
JapaneseQuestion: 動脈疾患疑いのbedside血管診察に含める項目は？
EnglishAnswer: Measure blood pressure in both arms; examine the heart and abdominal aorta; listen for bruits; inspect the legs; and palpate femoral, popliteal, posterior tibial, and dorsalis pedis pulses.
JapaneseAnswer: 両上肢血圧測定、心臓・腹部大動脈の診察、bruit聴取、下肢観察、femoral・popliteal・posterior tibial・dorsalis pedis pulse触知。

EnglishQuestion: How is the ankle-brachial index calculated for each leg?
JapaneseQuestion: 各下肢の足関節上腕血圧比（ABI）はどう計算するか？
EnglishAnswer: Divide the higher of the dorsalis pedis and posterior tibial systolic pressures in that leg by the higher brachial systolic pressure from either arm.
JapaneseAnswer: その下肢の足背動脈・後脛骨動脈収縮期圧の高い方を、左右上腕動脈収縮期圧の高い方で除する。

EnglishQuestion: How are ABI values interpreted?
JapaneseQuestion: ABI値をどう解釈するか？
EnglishAnswer: <=0.90 is abnormal, 0.91-0.99 is borderline, 1.00-1.40 is normal, and >1.40 indicates noncompressible arteries.
JapaneseAnswer: 0.90以下は異常、0.91～0.99は境界、1.00～1.40は正常、1.40超はnoncompressible artery。

EnglishQuestion: What should be used when ABI is falsely elevated by noncompressible arteries in diabetes or chronic kidney disease?
JapaneseQuestion: 糖尿病・CKDで動脈石灰化によりABIが偽高値の場合に用いる検査は？
EnglishAnswer: Toe-brachial index, toe pressure, and Doppler waveform assessment.
JapaneseAnswer: Toe-brachial index、toe pressure、Doppler waveform評価。

EnglishQuestion: What is the role of Doppler ultrasonography after an abnormal ABI?
JapaneseQuestion: 異常ABI後のDoppler超音波の役割は？
EnglishAnswer: Localize the arterial obstruction and determine the extent of atherosclerotic disease.
JapaneseAnswer: 動脈閉塞部位と動脈硬化の範囲を評価する。

EnglishQuestion: What is the main advantage of catheter angiography in arterial disease?
JapaneseQuestion: 動脈疾患でcatheter angiographyの主な利点は？
EnglishAnswer: It provides definitive vascular imaging and allows atherectomy, angioplasty, or stenting during the same procedure.
JapaneseAnswer: 確定的血管画像と同時にatherectomy、angioplasty、stentingを施行できる。

EnglishQuestion: How do CT angiography and MR angiography contribute to arterial assessment?
JapaneseQuestion: CT angiographyとMR angiographyは動脈評価にどう役立つか？
EnglishAnswer: CTA directly depicts the arterial system; MRA provides noninvasive high-resolution three-dimensional imaging and can cover the abdomen, pelvis, and lower limbs.
JapaneseAnswer: CTAは動脈系を直接描出し、MRAは非侵襲的高解像度3D画像で腹部・骨盤・下肢を広範囲に評価できる。

EnglishQuestion: How do neuropathic and ischemic diabetic feet differ on examination?
JapaneseQuestion: 神経障害性糖尿病足と虚血性糖尿病足の診察所見の違いは？
EnglishAnswer: A neuropathic foot is typically warm and dry with palpable pulses; an ischemic foot is cool and pale with absent pulses.
JapaneseAnswer: 神経障害性足は温かく乾燥しpulseを触知でき、虚血性足は冷たく蒼白でpulseを触知できない。

EnglishQuestion: What ulcer pattern suggests a predominantly neuropathic diabetic foot lesion?
JapaneseQuestion: 主に神経障害性の糖尿病足潰瘍を示唆する形態は？
EnglishAnswer: A round plantar ulcer surrounded by callus at a repetitive pressure point.
JapaneseAnswer: 反復圧迫部位に生じ、callusに囲まれた円形足底潰瘍。

EnglishQuestion: What findings suggest an ischemic component in a diabetic foot lesion?
JapaneseQuestion: 糖尿病足病変の虚血性要素を示唆する所見は？
EnglishAnswer: Distal dry gangrene, pallor, cool skin, and absent pulses.
JapaneseAnswer: 趾端の乾性gangrene、蒼白、冷感、pulse消失。

EnglishQuestion: Why should a diabetic foot not be classified as purely neuropathic or ischemic from appearance alone?
JapaneseQuestion: 糖尿病足を外観だけで純粋な神経障害性・虚血性に二分してはいけない理由は？
EnglishAnswer: Neuropathy, ischemia, and infection commonly coexist and each requires simultaneous assessment.
JapaneseAnswer: Neuropathy、ischemia、infectionが混在することが多く、同時評価が必要なため。

EnglishQuestion: Which wound features should be assessed in a diabetic foot ulcer?
JapaneseQuestion: 糖尿病足潰瘍で評価する創傷所見は？
EnglishAnswer: Location and depth, callus, necrosis, drainage, erythema, odor, and the probe-to-bone finding.
JapaneseAnswer: 部位・深さ、callus、壊死、排膿、発赤、悪臭、probe-to-bone所見。

EnglishQuestion: Which neurologic and mechanical factors should be assessed in a diabetic foot?
JapaneseQuestion: 糖尿病足で評価する神経学的・機械的要因は？
EnglishAnswer: Protective sensation, foot deformity, footwear, and weight-bearing pressure points.
JapaneseAnswer: 防御感覚、足変形、靴、荷重圧迫部位。

EnglishQuestion: Which diabetic-foot findings require urgent infection source control and vascular assessment?
JapaneseQuestion: 緊急の感染源制御と血行評価を要する糖尿病足所見は？
EnglishAnswer: Fever, rapidly spreading erythema, crepitus, or wet gangrene.
JapaneseAnswer: 発熱、急速に拡大する発赤、crepitus、wet gangrene。

EnglishQuestion: What are the core components of diabetic-foot ulcer treatment?
JapaneseQuestion: 糖尿病足潰瘍治療の中心要素は？
EnglishAnswer: Debridement, regular wound dressings, mechanical offloading with therapeutic footwear or devices, antibiotics for infection, and revascularization when peripheral arterial disease is present.
JapaneseAnswer: Debridement、定期的dressing、治療用靴などによるmechanical offloading、感染時の抗菌薬、PAD合併時の血行再建。

EnglishQuestion: When is amputation considered for diabetic foot disease?
JapaneseQuestion: 糖尿病足でamputationを検討するのはいつか？
EnglishAnswer: When limb-salvage measures fail or when severe complications threaten the patient's life.
JapaneseAnswer: 救肢治療が無効、または重症合併症が生命を脅かす場合。

EnglishQuestion: What is the diagnostic flow for suspected lower-extremity arterial disease?
JapaneseQuestion: 下肢動脈疾患疑いの診断フローは？
EnglishAnswer: Localize symptoms and examine bilateral pressures, pulses, and bruits -> measure ABI -> if abnormal, use Doppler ultrasound -> use CTA or MRA for anatomic planning -> reserve catheter angiography when definitive anatomy or simultaneous intervention is needed.
JapaneseAnswer: 症状分布と両上肢血圧・pulse・bruitを評価→ABI測定→異常ならDoppler超音波→解剖評価にCTA・MRA→確定解剖または同時介入が必要ならcatheter angiographyへ進む。

EnglishQuestion: Which nonmodifiable risk factors predispose to lower-extremity arterial disease?
JapaneseQuestion: 下肢動脈疾患の修正不能な危険因子は？
EnglishAnswer: Age, sex, ethnicity, and genetic background.
JapaneseAnswer: 年齢、性別、民族、遺伝背景。

EnglishQuestion: Which modifiable risk factors predispose to lower-extremity arterial disease?
JapaneseQuestion: 下肢動脈疾患の修正可能な危険因子は？
EnglishAnswer: Smoking, hypertension, diabetes, dyslipidemia, obesity, physical inactivity, hyperuricemia, hyperhomocysteinemia, and chronic kidney disease.
JapaneseAnswer: 喫煙、高血圧、糖尿病、脂質異常症、肥満、運動不足、高尿酸血症、高homocysteine血症、CKD。

EnglishQuestion: How commonly is lower-extremity arterial disease asymptomatic or atypical rather than classic claudication?
JapaneseQuestion: 下肢動脈疾患で無症候・非典型症状はclassic claudicationよりどの程度多いか？
EnglishAnswer: Only about 10-35% have classic claudication; approximately 40-50% have atypical leg symptoms and 20-50% are asymptomatic.
JapaneseAnswer: Classic claudicationは約10～35%のみで、約40～50%は非典型的下肢症状、20～50%は無症候性。

EnglishQuestion: Which chronic limb findings can indicate lower-extremity arterial insufficiency?
JapaneseQuestion: 慢性下肢動脈不全を示す所見は？
EnglishAnswer: Exertional pain or cramping, fatigue, numbness, aching, coolness, thick nails, smooth shiny skin, hair loss, and poor wound healing.
JapaneseAnswer: 労作時痛・cramp、疲労、しびれ、鈍痛、冷感、爪肥厚、平滑で光沢のある皮膚、脱毛、創傷治癒不良。

EnglishQuestion: How is peripheral pulse amplitude graded from 0 to 3?
JapaneseQuestion: 末梢pulse amplitudeを0～3でどう記載するか？
EnglishAnswer: 0 is absent, 1 diminished, 2 normal, and 3 bounding.
JapaneseAnswer: 0は消失、1は減弱、2は正常、3はbounding。

EnglishQuestion: Why should pulse contour terms such as tardus et parvus not be replaced by a simple amplitude grade?
JapaneseQuestion: Tardus et parvusなどのpulse contourを単純な振幅gradeで代用できない理由は？
EnglishAnswer: They describe the speed of upstroke and duration as well as strength, not amplitude alone.
JapaneseAnswer: 振幅だけでなく立ち上がり速度や持続時間を表すため。

EnglishQuestion: What should be done when ABI is borderline but exertional symptoms suggest PAD?
JapaneseQuestion: ABIがborderlineでも労作時症状からPADを疑う場合はどうするか？
EnglishAnswer: Consider exercise ABI testing.
JapaneseAnswer: 運動負荷ABIを検討する。

EnglishQuestion: What does an ABI of 0.90 or less indicate, and what can it not determine alone?
JapaneseQuestion: ABI 0.90以下は何を示し、単独では何を決められないか？
EnglishAnswer: It supports peripheral arterial disease but does not by itself determine symptoms or overall disease severity.
JapaneseAnswer: PADを支持するが、症状の有無や全体の重症度は単独では決められない。

EnglishQuestion: What does an ABI of 0.40 or less suggest?
JapaneseQuestion: ABI 0.40以下は何を示唆するか？
EnglishAnswer: Severe ischemia; in the presence of rest pain, wounds, or gangrene, assess chronic limb-threatening ischemia with toe pressure and other measures.
JapaneseAnswer: 高度虚血を示唆し、安静時痛、創傷、gangreneがあればtoe pressureなどを加えて慢性肢切迫虚血を評価する。

EnglishQuestion: How do Fontaine stages I through IV correspond to chronic lower-extremity ischemia?
JapaneseQuestion: Fontaine I～IV度は慢性下肢虚血の臨床像にどう対応するか？
EnglishAnswer: I is asymptomatic; IIa mild-to-moderate claudication; IIb severe lifestyle-limiting claudication; III ischemic rest pain; IV ulcer, gangrene, or other tissue loss.
JapaneseAnswer: Iは無症候、IIaは軽度～中等度claudication、IIbは高度生活制限性claudication、IIIは虚血性安静時痛、IVは潰瘍・gangreneなどの組織欠損。

EnglishQuestion: How does chronic Rutherford category correspond to the major chronic ischemia stages?
JapaneseQuestion: Chronic Rutherford categoryは慢性虚血段階にどう対応するか？
EnglishAnswer: Category 0 is asymptomatic; 1-3 represent increasing claudication; 4 is rest pain; 5-6 are minor or major tissue loss.
JapaneseAnswer: Category 0は無症候、1～3はclaudication増悪、4は安静時痛、5～6は軽度・高度組織欠損。

EnglishQuestion: Why must chronic Rutherford classification not be confused with acute limb ischemia Rutherford categories I-III?
JapaneseQuestion: Chronic Rutherford分類と急性下肢虚血Rutherford I～III分類を混同してはいけない理由は？
EnglishAnswer: The chronic system grades symptoms and tissue loss, whereas the acute system grades immediate limb viability and urgency of reperfusion.
JapaneseAnswer: 慢性分類は症状・組織欠損を、急性分類は患肢生存性と再灌流緊急度を評価する別の体系だから。

EnglishQuestion: What does the WIfI system integrate in chronic limb-threatening ischemia?
JapaneseQuestion: 慢性肢切迫虚血のWIfIは何を統合するか？
EnglishAnswer: Wound, ischemia, and foot infection.
JapaneseAnswer: 創傷、虚血、足感染。

EnglishQuestion: What are the three broad goals of chronic lower-extremity arterial disease treatment?
JapaneseQuestion: 慢性下肢動脈疾患治療の3つの大きな目標は？
EnglishAnswer: Reduce myocardial infarction and stroke, improve symptoms and functional quality of life, and prevent tissue loss and major amputation through limb salvage.
JapaneseAnswer: 心筋梗塞・stroke低減、症状・身体機能・QOL改善、組織欠損・大切断を防ぐlimb salvage。

EnglishQuestion: What is the foundation of conservative treatment for chronic lower-extremity arterial disease?
JapaneseQuestion: 慢性下肢動脈疾患の保存的治療の基盤は？
EnglishAnswer: Smoking cessation, lifestyle improvement, structured walking exercise, antiplatelet therapy, blood pressure control, lipid lowering, and glycemic management.
JapaneseAnswer: 禁煙、生活改善、構造化歩行訓練、抗血小板療法、血圧管理、脂質低下、血糖管理。

EnglishQuestion: How does cilostazol improve claudication, and what is its major contraindication?
JapaneseQuestion: Cilostazolはどうclaudicationを改善し、主な禁忌は何か？
EnglishAnswer: It inhibits PDE3, raises cAMP, suppresses platelet activation, and causes vasodilation to improve walking distance; it is contraindicated in heart failure.
JapaneseAnswer: PDE3阻害でcAMPを増やし、血小板活性化抑制と血管拡張により歩行距離を改善するが、心不全では禁忌。

EnglishQuestion: Which revascularization options are used for chronic lower-extremity arterial disease?
JapaneseQuestion: 慢性下肢動脈疾患の血行再建法は？
EnglishAnswer: Percutaneous transluminal angioplasty with or without stenting, or surgical bypass using an autologous vein such as the great saphenous vein.
JapaneseAnswer: PTA ± stent、または大伏在静脈など自家静脈を用いる外科的bypass。

EnglishQuestion: How is acute limb ischemia defined by symptom duration?
JapaneseQuestion: 急性下肢虚血は発症期間でどう定義するか？
EnglishAnswer: A marked reduction in arterial perfusion presenting within 14 days.
JapaneseAnswer: 発症14日以内の著明な動脈灌流低下。

EnglishQuestion: What are the major causes of acute limb ischemia?
JapaneseQuestion: 急性下肢虚血の主な原因は？
EnglishAnswer: Native arterial or graft thrombosis, cardiac embolism, dissection, trauma, and popliteal artery entrapment.
JapaneseAnswer: 自己動脈・graft血栓、心原性塞栓、解離、外傷、膝窩動脈entrapment。

EnglishQuestion: What are the six Ps of acute limb ischemia?
JapaneseQuestion: 急性下肢虚血の6 Psは？
EnglishAnswer: Pain, pallor, pulselessness, paralysis, paresthesia, and poikilothermia.
JapaneseAnswer: 疼痛、蒼白、脈拍消失、麻痺、感覚異常、冷感。

EnglishQuestion: Why should a universal six-hour cutoff not be used for acute limb ischemia?
JapaneseQuestion: 急性下肢虚血で全例一律6時間cutoffを用いない理由は？
EnglishAnswer: The salvage window depends on collateral circulation, occlusion level, and ischemia severity; Rutherford category and especially motor deficit determine urgency.
JapaneseAnswer: 救肢可能時間は側副血行、閉塞部位、虚血重症度で異なり、Rutherford category、特にmotor deficitが緊急度を決めるため。

EnglishQuestion: What defines Rutherford category I acute limb ischemia, and how is it managed?
JapaneseQuestion: 急性下肢虚血Rutherford Iの所見と方針は？
EnglishAnswer: The limb is viable with no sensory or motor deficit and both arterial and venous Doppler signals; obtain urgent imaging and plan revascularization.
JapaneseAnswer: 感覚・筋力低下がなく動静脈Dopplerを聴取できるviable limbで、緊急画像後に計画的血行再建を行う。

EnglishQuestion: How do Rutherford IIa and IIb acute limb ischemia differ?
JapaneseQuestion: 急性下肢虚血Rutherford IIaとIIbの違いは？
EnglishAnswer: IIa has sensory loss limited to the toes without weakness and needs prompt revascularization; IIb has sensory loss beyond the toes with mild-to-moderate weakness and needs immediate revascularization.
JapaneseAnswer: IIaは趾に限局する感覚障害で筋力低下がなく速やかな再灌流、IIbは趾を越える感覚障害と軽度～中等度筋力低下があり直ちに再灌流する。

EnglishQuestion: What defines Rutherford category III acute limb ischemia, and why is reperfusion avoided?
JapaneseQuestion: 急性下肢虚血Rutherford IIIの所見と再灌流を避ける理由は？
EnglishAnswer: Deep sensory loss, paralysis or rigor, and absent arterial and venous Doppler signals indicate irreversible ischemia; primary amputation is considered because reperfusion can cause dangerous systemic injury.
JapaneseAnswer: 深部感覚消失、麻痺・硬直、動静脈Doppler消失は不可逆虚血を示し、危険な再灌流障害を避けるため一次切断を検討する。

EnglishQuestion: What should be given immediately when acute limb ischemia is diagnosed?
JapaneseQuestion: 急性下肢虚血診断時に直ちに投与するものは？
EnglishAnswer: Intravenous heparin, analgesia, and oxygen as needed while limb viability is rapidly assessed.
JapaneseAnswer: 静注heparin、鎮痛、必要時酸素を開始し、患肢生存性を迅速評価する。

EnglishQuestion: Which open and percutaneous reperfusion options are available for acute limb ischemia?
JapaneseQuestion: 急性下肢虚血のopen・percutaneous再灌流法は？
EnglishAnswer: Open options include embolectomy, endarterectomy, patch angioplasty, and bypass; percutaneous options include catheter thrombolysis, aspiration, angioplasty, and stenting.
JapaneseAnswer: Openではembolectomy、endarterectomy、patch、bypass、percutaneousではcatheter thrombolysis、aspiration、PTA、stentを用いる。

EnglishQuestion: What is the emergency treatment flow for acute limb ischemia?
JapaneseQuestion: 急性下肢虚血の緊急治療フローは？
EnglishAnswer: Start IV heparin, analgesia, and oxygen -> rapidly determine Rutherford limb viability -> perform urgent or immediate open or endovascular reperfusion for salvageable limbs -> consider primary amputation for irreversible category III ischemia.
JapaneseAnswer: 静注heparin・鎮痛・酸素→Rutherfordで患肢生存性を迅速評価→救肢可能なら緊急・即時のopenまたはendovascular再灌流→不可逆なIIIでは一次切断を検討する。

EnglishQuestion: How is a diabetic foot with combined neuropathy, ischemia, and infection managed?
JapaneseQuestion: Neuropathy、ischemia、infectionが混在する糖尿病足はどう管理するか？
EnglishAnswer: Combine debridement, dressings, offloading, antibiotics only when infected, and revascularization for arterial disease; reserve amputation for nonsalvageable or life-threatening disease.
JapaneseAnswer: Debridement、dressing、offloading、感染時のみ抗菌薬、動脈疾患への血行再建を組み合わせ、救肢不能・生命危機でamputationを行う。

EnglishQuestion: What is the fundamental pathophysiology of chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全の基本病態は？
EnglishAnswer: Valve dysfunction, venous obstruction, or muscle-pump failure causes sustained venous hypertension, progressing from edema to skin fibrosis and ulceration.
JapaneseAnswer: 弁不全、静脈閉塞、筋pump機能低下が持続性静脈高血圧を起こし、浮腫から皮膚線維化・潰瘍へ進行する。

EnglishQuestion: Which mechanisms can cause chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全を起こす機序は？
EnglishAnswer: Venous valve incompetence, thrombotic occlusion, lymphatic obstruction, and impaired calf-muscle pump function.
JapaneseAnswer: 静脈弁不全、血栓性閉塞、リンパ閉塞、下腿筋pump機能低下。

EnglishQuestion: Which factors increase the risk of chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全の危険因子は？
EnglishAnswer: Older age, female sex, prolonged standing, obesity, smoking, pregnancy, previous thrombosis, and limb trauma.
JapaneseAnswer: 加齢、女性、長時間立位、肥満、喫煙、妊娠、血栓歴、四肢外傷歴。

EnglishQuestion: What is the pathophysiologic sequence from venous valve incompetence to venous ulcer?
JapaneseQuestion: 静脈弁不全から静脈性潰瘍に至る病態フローは？
EnglishAnswer: Valve incompetence -> reflux and venous hypertension -> superficial vein dilation -> protein and leukocyte extravasation with oxidative injury -> capillary basement-membrane injury -> edema and reduced oxygen delivery -> inflammation and tissue atrophy -> venous ulcer.
JapaneseAnswer: 弁不全→逆流・静脈高血圧→表在静脈拡張→蛋白・白血球漏出と酸化障害→毛細血管基底膜障害→浮腫・酸素供給低下→炎症・組織萎縮→静脈性潰瘍。

EnglishQuestion: Which symptoms are common in chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全で一般的な症状は？
EnglishAnswer: Lower-leg and ankle swelling, pain, discomfort, cramps, pruritus, tingling, and numbness.
JapaneseAnswer: 下腿・足関節腫脹、疼痛、不快感、cramp、pruritus、tingling、numbness。

EnglishQuestion: Why does chronic venous insufficiency cause brown skin pigmentation?
JapaneseQuestion: 慢性静脈不全で褐色色素沈着が生じる理由は？
EnglishAnswer: Hemosiderin from extravasated and degraded erythrocytes deposits in the dermis.
JapaneseAnswer: 血管外へ漏出・分解した赤血球由来のhemosiderinが真皮に沈着するため。

EnglishQuestion: What is lipodermatosclerosis?
JapaneseQuestion: Lipodermatosclerosisとは？
EnglishAnswer: Chronic inflammation and fibrosis of the skin and subcutaneous tissue of the lower leg due to venous hypertension.
JapaneseAnswer: 静脈高血圧による下腿皮膚・皮下組織の慢性炎症と線維化。

EnglishQuestion: What do CEAP clinical classes C0 through C3 represent?
JapaneseQuestion: CEAP clinical class C0～C3は何を表すか？
EnglishAnswer: C0: no visible or palpable sign; C1: telangiectasia or reticular veins; C2: varicose veins, usually at least 3 mm; C3: edema.
JapaneseAnswer: C0は可視・触知所見なし、C1はtelangiectasia・reticular vein、C2は通常3 mm以上のvaricose vein、C3はedema。

EnglishQuestion: What do CEAP clinical classes C4a, C4b, and C4c represent?
JapaneseQuestion: CEAP clinical class C4a・C4b・C4cは何を表すか？
EnglishAnswer: C4a: pigmentation or venous eczema; C4b: lipodermatosclerosis or atrophie blanche; C4c: corona phlebectatica.
JapaneseAnswer: C4aは色素沈着・静脈性湿疹、C4bはlipodermatosclerosis・atrophie blanche、C4cはcorona phlebectatica。

EnglishQuestion: How do CEAP classes C5 and C6 differ?
JapaneseQuestion: CEAP C5とC6の違いは？
EnglishAnswer: C5 indicates a healed venous ulcer; C6 indicates an active venous ulcer.
JapaneseAnswer: C5は治癒した静脈性潰瘍、C6は活動性静脈性潰瘍。

EnglishQuestion: Which four dimensions make up the full CEAP classification?
JapaneseQuestion: 完全なCEAP分類を構成する4要素は？
EnglishAnswer: Clinical class, etiology, anatomy, and pathophysiology.
JapaneseAnswer: 臨床分類、病因、解剖、病態生理。

EnglishQuestion: What do Ep, Es, and Ec mean in CEAP etiology?
JapaneseQuestion: CEAP etiologyのEp・Es・Ecは何を意味するか？
EnglishAnswer: Ep is primary, Es secondary, and Ec congenital venous disease.
JapaneseAnswer: Epはprimary、Esはsecondary、Ecはcongenitalな静脈疾患。

EnglishQuestion: What do As, Ad, and Ap mean in CEAP anatomy?
JapaneseQuestion: CEAP anatomyのAs・Ad・Apは何を意味するか？
EnglishAnswer: As is superficial, Ad deep, and Ap perforator venous involvement.
JapaneseAnswer: Asは表在静脈、Adは深部静脈、Apは穿通枝病変。

EnglishQuestion: What do Pr, Po, and Pr,o mean in CEAP pathophysiology?
JapaneseQuestion: CEAP pathophysiologyのPr・Po・Pr,oは何を意味するか？
EnglishAnswer: Pr is reflux, Po obstruction, and Pr,o combined reflux and obstruction.
JapaneseAnswer: Prは逆流、Poは閉塞、Pr,oは逆流と閉塞の併存。

EnglishQuestion: How is the CEAP description C6, Es, Ad, Pr,o interpreted?
JapaneseQuestion: CEAP記載C6, Es, Ad, Pr,oをどう解釈するか？
EnglishAnswer: An active venous ulcer caused by secondary deep venous disease with both reflux and obstruction.
JapaneseAnswer: 活動性静脈性潰瘍を伴うsecondary deep venous diseaseで、逆流と閉塞が併存する。

EnglishQuestion: Why does CEAP clinical class alone not determine treatment?
JapaneseQuestion: CEAP clinical classだけで治療法を決められない理由は？
EnglishAnswer: Treatment depends on the reflux or obstruction site identified by duplex ultrasonography, ulcer status, and the patient's overall condition.
JapaneseAnswer: 治療はduplex超音波で同定した逆流・閉塞部位、潰瘍状態、全身状態に依存するため。

EnglishQuestion: How is the Trendelenburg test performed?
JapaneseQuestion: Trendelenburg testはどう行うか？
EnglishAnswer: With the patient supine, elevate the leg to empty superficial veins, compress the great saphenous region with a tourniquet, then have the patient stand and observe venous filling before and after tourniquet release.
JapaneseAnswer: 仰臥位で下肢を挙上し表在静脈を空にしてgreat saphenous領域をtourniquetで圧迫し、立位で解除前後の静脈充満を観察する。

EnglishQuestion: What do positive Trendelenburg I and II tests indicate?
JapaneseQuestion: Trendelenburg I陽性とII陽性は何を示すか？
EnglishAnswer: Rapid filling from deep to superficial veins while standing with the tourniquet on indicates perforator insufficiency (I); rapid filling after tourniquet release indicates superficial valve insufficiency (II).
JapaneseAnswer: Tourniquet装着中の立位で深部から表在へ急速充満すれば穿通枝不全（I）、解除後に急速充満すれば表在静脈弁不全（II）。

EnglishQuestion: What is the principal imaging test for chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全の中心的画像検査は？
EnglishAnswer: Duplex ultrasonography to detect reflux and obstruction and to map veins before intervention.
JapaneseAnswer: Duplex超音波で逆流・閉塞を検出し、介入前mappingを行う。

EnglishQuestion: When are MR venography and venous plethysmography useful in chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全でMR venographyとvenous plethysmographyはいつ有用か？
EnglishAnswer: MR venography depicts anatomy, reflux, and obstruction in complex or equivocal ultrasound cases; plethysmography noninvasively measures venous refill time.
JapaneseAnswer: MR venographyは複雑例・超音波不確定例で解剖、逆流、閉塞を描出し、plethysmographyは静脈再充満時間を非侵襲的に測定する。

EnglishQuestion: What is the foundation of conservative treatment for chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全の保存的治療の基盤は？
EnglishAnswer: Compression stockings, exercise, weight loss, manual lymphatic drainage, and avoidance of prolonged standing or sitting with flexed knees.
JapaneseAnswer: 弾性stocking、運動、減量、用手的リンパdrainage、長時間立位・膝を曲げた座位の回避。

EnglishQuestion: Are diuretics routine treatment for chronic venous insufficiency?
JapaneseQuestion: 利尿薬は慢性静脈不全のroutine治療か？
EnglishAnswer: No. Consider them only when a separate volume-overload condition such as heart failure is present.
JapaneseAnswer: Routineには用いず、心不全など別の容量過剰病態を併存する場合のみ検討する。

EnglishQuestion: What is the role of pentoxifylline in chronic venous insufficiency?
JapaneseQuestion: 慢性静脈不全におけるpentoxifyllineの役割は？
EnglishAnswer: It may be used as an adjunct to compression therapy, especially for venous ulcers.
JapaneseAnswer: 特に静脈性潰瘍でcompression therapyの補助として用いることがある。

EnglishQuestion: Which interventions can eliminate pathologic venous reflux in severe chronic venous insufficiency?
JapaneseQuestion: 重症慢性静脈不全で病的静脈逆流を処理する介入は？
EnglishAnswer: Endovenous thermal ablation with laser or radiofrequency, sclerotherapy, or surgical ligation and stripping, selected according to the lesion.
JapaneseAnswer: 病変に応じてlaser・radiofrequencyによる血管内熱焼灼、sclerotherapy、外科的結紮・strippingを行う。

EnglishQuestion: Which two complications are the main prevention targets in deep vein thrombosis?
JapaneseQuestion: 深部静脈血栓症で予防すべき主な2つの合併症は？
EnglishAnswer: Early pulmonary embolism and late post-thrombotic syndrome.
JapaneseAnswer: 早期の肺塞栓症と晩期の血栓後症候群。

EnglishQuestion: Which veins are commonly affected by proximal lower-extremity DVT?
JapaneseQuestion: 近位下肢DVTでよく侵される静脈は？
EnglishAnswer: The iliac, femoral, and popliteal veins.
JapaneseAnswer: 腸骨静脈、大腿静脈、膝窩静脈。

EnglishQuestion: What does venous thromboembolism include?
JapaneseQuestion: 静脈血栓塞栓症（VTE）には何が含まれるか？
EnglishAnswer: Deep vein thrombosis and pulmonary embolism.
JapaneseAnswer: 深部静脈血栓症と肺塞栓症。

EnglishQuestion: Which major transient factors can provoke DVT?
JapaneseQuestion: DVTを誘発する主な一過性因子は？
EnglishAnswer: Hip or knee replacement, major trauma, acute heart or respiratory failure, central venous catheterization, hospitalization, bed rest, and prolonged travel.
JapaneseAnswer: 股・膝関節置換、major trauma、急性心不全・呼吸不全、中心静脈catheter、入院、bed rest、長距離移動。

EnglishQuestion: Which persistent or patient-related factors predispose to DVT?
JapaneseQuestion: DVTの持続性・患者関連素因は？
EnglishAnswer: Older age, immobility, previous VTE, obesity, pregnancy, thrombophilia, hormonal therapy, renal failure, inflammatory bowel disease, and malignancy.
JapaneseAnswer: 高齢、immobility、VTE既往、肥満、妊娠、thrombophilia、hormonal therapy、腎不全、IBD、悪性腫瘍。

EnglishQuestion: What are the three components of Virchow triad?
JapaneseQuestion: Virchow triadの3要素は？
EnglishAnswer: Endothelial injury, hypercoagulability, and venous stasis.
JapaneseAnswer: 血管内皮障害、過凝固、静脈うっ滞。

EnglishQuestion: Which unilateral leg findings suggest DVT?
JapaneseQuestion: DVTを示唆する片側下肢所見は？
EnglishAnswer: Swelling, tightness or heaviness, warmth, erythema or livid discoloration, distended superficial veins, tenderness or dull pain, and sometimes fever.
JapaneseAnswer: 腫脹、緊満・重感、熱感、紅斑・暗赤色変化、表在静脈怒張、圧痛・鈍痛、発熱。

EnglishQuestion: Which symptoms in a patient with suspected DVT suggest pulmonary embolism?
JapaneseQuestion: DVT疑い患者で肺塞栓症を示唆する症状は？
EnglishAnswer: Dyspnea, chest pain, dizziness, and weakness.
JapaneseAnswer: 呼吸困難、胸痛、めまい、脱力。

EnglishQuestion: Why should Homan, Meyer, and Payr signs not be used to diagnose or exclude DVT?
JapaneseQuestion: Homan・Meyer・Payr signだけでDVTを診断・除外できない理由は？
EnglishAnswer: They have inadequate sensitivity and specificity.
JapaneseAnswer: 感度・特異度が不十分なため。

EnglishQuestion: Which findings add one point each in the two-level Wells DVT score?
JapaneseQuestion: Two-level Wells DVT scoreで各+1点となる項目は？
EnglishAnswer: Active cancer; leg paralysis, paresis, or recent cast; bed rest for at least 3 days or major surgery within 12 weeks; deep venous tenderness; entire-leg swelling; calf difference >=3 cm; unilateral pitting edema; nonvaricose collateral veins; and previous DVT.
JapaneseAnswer: 活動性癌、下肢麻痺・不全麻痺・最近のcast、3日以上bed restまたは12週以内major surgery、深部静脈圧痛、下肢全体腫脹、下腿周径差3 cm以上、片側pitting edema、非静脈瘤性側副表在静脈、DVT既往。

EnglishQuestion: Which Wells DVT item subtracts two points?
JapaneseQuestion: Wells DVT scoreで-2点となる項目は？
EnglishAnswer: An alternative diagnosis at least as likely as DVT.
JapaneseAnswer: DVTと同程度以上に考えやすい代替診断。

EnglishQuestion: How is the two-level Wells DVT score interpreted?
JapaneseQuestion: Two-level Wells DVT scoreをどう解釈するか？
EnglishAnswer: A score of 2 or more means DVT likely; 1 or less means DVT unlikely.
JapaneseAnswer: 2点以上はDVT likely、1点以下はDVT unlikely。

EnglishQuestion: Why must the two-level and three-level Wells models not be mixed?
JapaneseQuestion: Two-levelとthree-level Wells modelを混在させてはいけない理由は？
EnglishAnswer: They use different category thresholds and connect to different diagnostic algorithms.
JapaneseAnswer: 分類閾値が異なり、それぞれ異なる診断algorithmに接続するため。

EnglishQuestion: What is the diagnostic flow when DVT pretest probability is low?
JapaneseQuestion: DVT検査前確率が低い場合の診断フローは？
EnglishAnswer: Obtain D-dimer -> a negative result excludes DVT in the appropriate low-risk setting -> a positive result requires compression ultrasonography.
JapaneseAnswer: D-dimer測定→適切な低risk状況で陰性ならDVT除外→陽性なら圧迫超音波。

EnglishQuestion: What is the diagnostic flow when DVT pretest probability is high?
JapaneseQuestion: DVT検査前確率が高い場合の診断フローは？
EnglishAnswer: Proceed directly to compression ultrasonography without waiting for D-dimer; if the first study is negative but suspicion remains high, repeat ultrasonography or obtain additional imaging.
JapaneseAnswer: D-dimerを待たず圧迫超音波へ進み、初回陰性でも疑いが強ければ再検または追加画像を行う。

EnglishQuestion: What fixed D-dimer threshold is commonly used, and how may it be adjusted in older adults?
JapaneseQuestion: D-dimerの一般的固定閾値と高齢者での調整は？
EnglishAnswer: A common cutoff is 500 ng/mL FEU; an age-adjusted threshold may be used above age 50 after confirming assay units and method.
JapaneseAnswer: 一般的cutoffは500 ng/mL FEUで、50歳超では測定単位・方法を確認して年齢調整閾値を用いることがある。

EnglishQuestion: Can a negative D-dimer alone exclude DVT when pretest probability is high?
JapaneseQuestion: 検査前確率が高い場合にD-dimer陰性だけでDVTを除外できるか？
EnglishAnswer: No.
JapaneseAnswer: できない。

EnglishQuestion: What is the first-line imaging test for DVT, and what finding is central?
JapaneseQuestion: DVTの第一選択画像検査と中心所見は？
EnglishAnswer: Compression duplex ultrasonography; venous noncompressibility is the central finding, together with flow assessment.
JapaneseAnswer: 圧迫duplex超音波で、静脈の非圧縮性と血流所見を評価する。

EnglishQuestion: When is contrast venography considered in suspected DVT?
JapaneseQuestion: DVT疑いでcontrast venographyを検討するのはいつか？
EnglishAnswer: When ultrasonography is inconclusive and clinical suspicion persists or when an intervention is planned; it is not routine because it is invasive.
JapaneseAnswer: 超音波が不確定で疑いが残る場合や介入時に限り検討し、侵襲的なためroutineには行わない。

EnglishQuestion: When should thrombophilia testing be considered after DVT?
JapaneseQuestion: DVT後にthrombophilia検査を検討するのはいつか？
EnglishAnswer: Selectively in younger patients, those with a family history, or thrombosis at an unusual site, with timing chosen because acute thrombosis and anticoagulants can alter results.
JapaneseAnswer: 若年、家族歴、非典型部位の血栓で選択的に検討し、急性血栓期・抗凝固薬の影響を考えて検査時期を決める。

EnglishQuestion: How should occult malignancy be assessed after unprovoked DVT without other suspicious findings?
JapaneseQuestion: 他に疑わしい所見のない非誘発性DVT後の潜在癌検索は？
EnglishAnswer: Perform age-appropriate standard cancer screening rather than extensive testing in every patient.
JapaneseAnswer: 年齢相応の標準的癌screeningを行い、全例へ過剰な検索はしない。

EnglishQuestion: How is warfarin initiated for acute DVT?
JapaneseQuestion: 急性DVTでwarfarinをどう開始するか？
EnglishAnswer: Overlap it with LMWH or unfractionated heparin until the INR is stable in the therapeutic range.
JapaneseAnswer: LMWHまたは未分画heparinと重ねて開始し、INRが治療域で安定するまで併用する。

EnglishQuestion: Which direct oral anticoagulants can be started without preceding heparin, and which usually require it?
JapaneseQuestion: 先行heparinなしで開始できるDOACと、通常必要なDOACは？
EnglishAnswer: Rivaroxaban and apixaban have initial intensified regimens without heparin; dabigatran and edoxaban usually follow a course of parenteral anticoagulation.
JapaneseAnswer: Rivaroxaban・apixabanは先行heparin不要の初期増量regimenがあり、dabigatran・edoxabanは通常注射抗凝固薬後に開始する。

EnglishQuestion: What is the minimum usual anticoagulation period for DVT?
JapaneseQuestion: DVT抗凝固療法の通常の最短期間は？
EnglishAnswer: At least 3 months, individualized according to provoking factors and recurrence and bleeding risks.
JapaneseAnswer: 少なくとも3か月を基準とし、誘因、再発risk、出血riskで個別化する。

EnglishQuestion: When are thrombolysis or catheter-directed treatment considered for DVT?
JapaneseQuestion: DVTで血栓溶解・catheter治療を検討するのはいつか？
EnglishAnswer: In selected acute extensive iliofemoral DVT or phlegmasia with low bleeding risk, not routinely for all DVT.
JapaneseAnswer: 出血riskが低い選択された急性広範腸骨大腿DVTやphlegmasiaで検討し、全例には行わない。

EnglishQuestion: When is an inferior vena cava filter considered in acute VTE?
JapaneseQuestion: 急性VTEで下大静脈filterを検討するのはいつか？
EnglishAnswer: When anticoagulation is absolutely contraindicated or VTE recurs despite appropriate anticoagulation; remove a retrievable filter when no longer needed.
JapaneseAnswer: 抗凝固が絶対禁忌、または適切な抗凝固中にも再発する場合に検討し、回収可能型は不要になり次第抜去する。

EnglishQuestion: What causes post-thrombotic syndrome, and how does it present?
JapaneseQuestion: 血栓後症候群の機序と症状は？
EnglishAnswer: Residual obstruction and valvular reflux cause venous hypertension, producing pain, heaviness, venous dilation, edema, pigmentation, and venous ulceration.
JapaneseAnswer: 残存閉塞と弁逆流が静脈高血圧を起こし、疼痛、重感、静脈拡張、浮腫、色素沈着、静脈性潰瘍を生じる。

EnglishQuestion: What is the main conceptual difference between endovascular and open vascular treatment?
JapaneseQuestion: 血管内治療とopen vascular treatmentの基本的違いは？
EnglishAnswer: Endovascular treatment dilates or supports a vessel from within using catheters; open surgery exposes the vessel to remove thrombus or plaque or reconstruct the artery directly.
JapaneseAnswer: 血管内治療はcatheterで内側から拡張・支持し、open surgeryは血管を露出して血栓・plaque除去または直接再建する。

EnglishQuestion: What are major practical advantages of percutaneous endovascular treatment over open surgery?
JapaneseQuestion: 経皮的血管内治療のopen surgeryに対する主な実用的利点は？
EnglishAnswer: Lower invasiveness, morbidity, and mortality; no surgical cutdown or general anesthesia in many cases; and possible outpatient treatment.
JapaneseAnswer: 低侵襲で罹患率・死亡率が低く、多くはcutdown・全身麻酔が不要で外来施行も可能。

EnglishQuestion: What is the sequence of the Seldinger technique?
JapaneseQuestion: Seldinger法の手順は？
EnglishAnswer: Puncture the vessel with a hollow needle -> insert a round-tipped guidewire -> remove the needle -> advance a sheath or cannula over the wire -> remove the wire and insert the catheter.
JapaneseAnswer: 中空針で血管穿刺→round-tipped guidewire挿入→針抜去→wire上にsheath・cannula挿入→wireを抜きcatheter挿入。

EnglishQuestion: Which treatments can be performed during catheter angiography?
JapaneseQuestion: Catheter angiography中に同時施行できる治療は？
EnglishAnswer: Atherectomy, balloon angioplasty, and stenting.
JapaneseAnswer: 粥腫切除、balloon血管形成、stent留置。

EnglishQuestion: What are the strengths and limitations of balloon angioplasty?
JapaneseQuestion: Balloon angioplastyの長所と限界は？
EnglishAnswer: It is flexible and can reach small vessels, but elastic recoil, flow-limiting dissection, and heavily calcified plaque can limit success.
JapaneseAnswer: 柔軟で小血管にも到達できるが、elastic recoil、血流制限性dissection、高度石灰化plaqueが限界となる。

EnglishQuestion: What are major indications for vascular stent placement?
JapaneseQuestion: 血管stent留置の主な適応は？
EnglishAnswer: Long stenosis or occlusion, unstable or flow-limiting dissection, venous stenosis, and failed balloon angioplasty.
JapaneseAnswer: 長区間狭窄・閉塞、不安定または血流制限性dissection、静脈狭窄、PTA不成功。

EnglishQuestion: What causes restenosis after endovascular intervention, and how can it be reduced?
JapaneseQuestion: 血管内治療後restenosisの機序と抑制法は？
EnglishAnswer: Intervention-induced injury triggers intimal proliferation; drug-eluting devices can reduce this response.
JapaneseAnswer: 介入損傷が内膜増殖を起こし、drug-eluting deviceで抑制できる。

EnglishQuestion: How do balloon-expandable and self-expanding stents differ?
JapaneseQuestion: Balloon-expandable stentとself-expanding stentの違いは？
EnglishAnswer: Balloon-expandable stents allow precise placement, little shortening, and high radial force but are rigid and externally deformable; self-expanding stents maintain expansion and conform to diameter changes and bends but may shorten as diameter increases.
JapaneseAnswer: Balloon-expandableは位置決めが正確で短縮が少なくradial forceが高いが硬く外力で変形し得る。Self-expandingは持続的拡張力があり径変化・屈曲へ追従するが、拡径時に短縮し得る。

EnglishQuestion: What are the roles of the guidewire, balloon, and stent during endovascular treatment?
JapaneseQuestion: 血管内治療でguidewire、balloon、stentはそれぞれ何をするか？
EnglishAnswer: The wire acts as a rail, the balloon dilates the lesion, and the stent serves as a scaffold after expansion.
JapaneseAnswer: Wireはrail、balloonは病変拡張部、stentは拡張後のscaffoldとして働く。

EnglishQuestion: Why are balloon-expandable stents useful for ostial lesions?
JapaneseQuestion: Balloon-expandable stentがostial lesionに適する理由は？
EnglishAnswer: They are crimped on a balloon and expand at the targeted position with precise placement.
JapaneseAnswer: Balloon上にcrimpされ、狙った位置で同時拡張し精密に留置できるため。

EnglishQuestion: Why are self-expanding stents useful in curved or externally compressed segments?
JapaneseQuestion: Self-expanding stentが屈曲・外部圧迫segmentに適する理由は？
EnglishAnswer: They deploy after sheath withdrawal and conform to bending, compression, and changing vessel diameter.
JapaneseAnswer: Sheathを引いて自己展開し、屈曲、圧迫、血管径変化へ追従するため。

EnglishQuestion: Which complications should proper stent sizing seek to avoid?
JapaneseQuestion: 適切なstent sizingで避けるべき合併症は？
EnglishAnswer: Oversizing, edge dissection, branch coverage, stent fracture, and in-stent restenosis.
JapaneseAnswer: Oversizing、edge dissection、分枝被覆、stent fracture、in-stent restenosis。

EnglishQuestion: What is the general revascularization approach for aortoiliac disease?
JapaneseQuestion: Aortoiliac病変の一般的血行再建方針は？
EnglishAnswer: Endovascular treatment is often favored, including kissing stents at the aortic bifurcation, while long occlusions, multifocal disease, or heavy calcification may require open or hybrid reconstruction.
JapaneseAnswer: 血管内治療を選びやすく、大動脈分岐ではkissing stentを用いる。長区間閉塞、多発病変、高度石灰化ではopen・hybrid再建も比較する。

EnglishQuestion: Which factors guide endovascular versus bypass selection in femoropopliteal disease?
JapaneseQuestion: Femoro-popliteal病変で血管内治療とbypassを選ぶ要因は？
EnglishAnswer: Symptoms, lesion anatomy and length, calcification and mechanical stress, device characteristics, available autologous vein, and surgical risk.
JapaneseAnswer: 症状、病変解剖・長さ、石灰化・外力、device特性、利用可能な自家静脈、手術risk。

EnglishQuestion: What is the revascularization goal in infrapopliteal chronic limb-threatening ischemia?
JapaneseQuestion: 膝下の慢性肢切迫虚血における血行再建目標は？
EnglishAnswer: Establish in-line arterial flow to the wound-bearing region.
JapaneseAnswer: 創傷部までのin-line arterial flowを確保する。

EnglishQuestion: Which factors determine bypass versus endovascular treatment in chronic limb-threatening ischemia?
JapaneseQuestion: 慢性肢切迫虚血でbypassと血管内治療を選ぶ要因は？
EnglishAnswer: WIfI limb severity, lesion anatomy, usable autologous vein, comorbidities, life expectancy, and patient preference.
JapaneseAnswer: WIfIによる患肢重症度、病変解剖、使用可能な自家静脈、併存症、期待余命、患者希望。

EnglishQuestion: How is chronic limb-threatening ischemia defined, and what are its treatment goals?
JapaneseQuestion: 慢性肢切迫虚血の定義と治療目標は？
EnglishAnswer: Chronic ischemic rest pain, a nonhealing ulcer, or gangrene due to PAD; goals are pain relief, wound healing, and limb salvage.
JapaneseAnswer: PADに伴う慢性虚血性安静時痛、非治癒性潰瘍、gangreneで、治療目標は疼痛軽減、創傷治癒、limb salvage。

EnglishQuestion: Why does technical revascularization success not guarantee wound healing?
JapaneseQuestion: 血行再建のtechnical successだけで創傷治癒が保証されない理由は？
EnglishAnswer: Collateral flow, microangiopathy, infection, and wound depth also affect healing.
JapaneseAnswer: 側副血行、microangiopathy、感染、創傷深度も治癒へ影響するため。

EnglishQuestion: What are the basic categories of open vascular surgical technique?
JapaneseQuestion: Open vascular surgeryの基本手技カテゴリーは？
EnglishAnswer: Arteriotomy; thrombectomy, embolectomy, or endarterectomy; and reconstruction by closure, bypass, or interposition.
JapaneseAnswer: Arteriotomy、thrombectomy・embolectomy・endarterectomy、closure・bypass・interpositionによる再建。

EnglishQuestion: How do transverse and longitudinal arteriotomy differ?
JapaneseQuestion: Transverse arteriotomyとlongitudinal arteriotomyの違いは？
EnglishAnswer: A transverse incision is perpendicular to the vessel axis without complete transection; a longitudinal incision follows the vessel axis and is useful in thickened or plaque-bearing walls.
JapaneseAnswer: Transverseは長軸に垂直で完全離断せず、longitudinalは長軸に平行で肥厚・plaque性壁に用いる。

EnglishQuestion: How is Fogarty embolectomy performed?
JapaneseQuestion: Fogarty embolectomyはどう行うか？
EnglishAnswer: Pass the catheter beyond the embolus, inflate the balloon distal to it, and withdraw the balloon proximally to extract the clot.
JapaneseAnswer: Catheterを血栓遠位へ通し、balloonを膨らませて近位へ引き抜き血栓を摘出する。

EnglishQuestion: How do embolectomy and thrombectomy differ in common vascular-surgery usage?
JapaneseQuestion: 血管外科でembolectomyとthrombectomyは一般にどう使い分けるか？
EnglishAnswer: Embolectomy urgently removes an embolus from an artery; thrombectomy often reopens a thrombosed existing graft.
JapaneseAnswer: Embolectomyは動脈塞栓を緊急摘出し、thrombectomyは主に血栓閉塞した既存graftを再開通する。

EnglishQuestion: How do open and eversion endarterectomy differ?
JapaneseQuestion: Open endarterectomyとeversion endarterectomyの違いは？
EnglishAnswer: Open endarterectomy removes plaque through a longitudinal incision followed by patch closure; eversion endarterectomy transects and everts the internal carotid artery, removes plaque, and reanastomoses it.
JapaneseAnswer: Openは縦切開からplaqueを除去してpatch closureし、eversionは内頸動脈を横切・反転してplaqueを除去後に再吻合する。

EnglishQuestion: Why is patch closure used after open endarterectomy?
JapaneseQuestion: Open endarterectomy後にpatch closureを行う理由は？
EnglishAnswer: To prevent luminal narrowing that could result from primary closure.
JapaneseAnswer: 単純縫合による内腔狭窄を避けるため。

EnglishQuestion: How do interposition grafting and bypass differ?
JapaneseQuestion: Interposition graftとbypassの違いは？
EnglishAnswer: Interposition removes the diseased segment and replaces it end-to-end, often for aneurysm; bypass leaves the lesion in place and creates an alternate end-to-side route, often for occlusive disease.
JapaneseAnswer: Interpositionは病変segmentを切除して端々吻合で置換し、主にaneurysmに用いる。Bypassは病変を残して端側吻合の別経路を作り、主に閉塞性病変に用いる。

EnglishQuestion: What materials are examples of autograft, allograft, xenograft, and synthetic vascular grafts?
JapaneseQuestion: Autograft、allograft、xenograft、synthetic graftの材料例は？
EnglishAnswer: Autograft: great saphenous or femoral vein; allograft: cryopreserved human vessel; xenograft: bovine pericardial patch; synthetic: Dacron or PTFE.
JapaneseAnswer: Autograftは大伏在・大腿静脈、allograftは凍結ヒト血管、xenograftは牛心膜patch、syntheticはDacron・PTFE。

EnglishQuestion: How do Dacron, PTFE, and autologous vein differ in preferred vascular use?
JapaneseQuestion: Dacron、PTFE、自家静脈の適する再建部位は？
EnglishAnswer: Dacron is favored for large high-flow aortic or aortoiliac reconstruction; PTFE is used in peripheral arteries and prosthetic AV grafts; autologous vein is especially valuable for small-caliber infrainguinal bypass and infected fields.
JapaneseAnswer: Dacronは大径高流量の大動脈・aortoiliac再建、PTFEは末梢動脈・人工AV graft、自家静脈は小径infrainguinal bypassや感染野で特に有用。

EnglishQuestion: Why can disease of the supraaortic branches cause both neurologic and upper-extremity symptoms?
JapaneseQuestion: 大動脈弓上分枝病変が神経症状と上肢症状の両方を起こす理由は？
EnglishAnswer: The brachiocephalic, subclavian, and carotid systems supply both the brain and upper limbs.
JapaneseAnswer: 腕頭、鎖骨下、頸動脈系が脳と上肢の両方を灌流するため。

EnglishQuestion: Which supraaortic arterial lesions are generally treated when intervention is considered?
JapaneseQuestion: 大動脈弓上分枝病変で主に介入対象となるのは？
EnglishAnswer: Symptomatic central nervous system or upper-extremity lesions.
JapaneseAnswer: 症候性の中枢神経または上肢病変。

EnglishQuestion: Why is endovascular treatment often preferred for subclavian or brachiocephalic stenosis or occlusion?
JapaneseQuestion: 鎖骨下・腕頭動脈狭窄・閉塞で血管内治療を選びやすい理由は？
EnglishAnswer: Open surgical access is difficult, making an endovascular-first strategy less invasive.
JapaneseAnswer: Open surgeryの到達が難しく、血管内治療が低侵襲なため。

EnglishQuestion: Where does carotid atherosclerosis most commonly develop?
JapaneseQuestion: 頸動脈atherosclerosisの好発部位は？
EnglishAnswer: At the carotid bifurcation.
JapaneseAnswer: 頸動脈分岐部。

EnglishQuestion: How does unstable internal carotid plaque cause TIA or stroke?
JapaneseQuestion: 不安定な内頸動脈plaqueはどうTIA・strokeを起こすか？
EnglishAnswer: Plaque debris or thrombus embolizes into the cerebral or retinal circulation.
JapaneseAnswer: Plaque debrisや血栓が脳・網膜循環へ塞栓する。

EnglishQuestion: Which symptoms suggest embolism from internal carotid stenosis?
JapaneseQuestion: 内頸動脈狭窄からの塞栓を示唆する症状は？
EnglishAnswer: Transient unilateral limb or body weakness or sensory loss, monocular vision loss, or thromboembolic stroke.
JapaneseAnswer: 一過性の片側肢・体幹脱力または感覚消失、片眼視力消失、血栓塞栓性stroke。

EnglishQuestion: Which imaging tests are used to evaluate internal carotid artery stenosis?
JapaneseQuestion: 内頸動脈狭窄の評価に用いる画像検査は？
EnglishAnswer: Color-flow duplex ultrasonography as the basic test, supplemented by CTA or MRA.
JapaneseAnswer: Color-flow duplex超音波を基本とし、CTA・MRAを追加する。

EnglishQuestion: What is the most serious complication of carotid endarterectomy?
JapaneseQuestion: 頸動脈内膜剥離術の最重篤合併症は？
EnglishAnswer: Stroke.
JapaneseAnswer: 脳卒中。

EnglishQuestion: Which factors guide carotid endarterectomy in symptomatic internal carotid stenosis?
JapaneseQuestion: 症候性内頸動脈狭窄でendarterectomy適応を決める要因は？
EnglishAnswer: Stenosis severity, time since neurologic symptoms, age, and comorbidities.
JapaneseAnswer: 狭窄率、神経症状発症からの時期、年齢、併存症。

EnglishQuestion: When is carotid artery stenting considered instead of endarterectomy?
JapaneseQuestion: Endarterectomyの代わりに頸動脈stentingを検討するのはいつか？
EnglishAnswer: When surgical risk is high or access is difficult, including restenosis, radiation-induced stenosis, severe cardiopulmonary disease, prior neck surgery, or surgically inaccessible anatomy.
JapaneseAnswer: 外科riskが高い、または到達困難な場合で、restenosis、放射線性狭窄、重症心肺疾患、頸部手術歴、外科的到達困難解剖など。

EnglishQuestion: What is the treatment foundation for asymptomatic carotid stenosis?
JapaneseQuestion: 無症候性頸動脈狭窄の治療基盤は？
EnglishAnswer: Optimal medical therapy; intervention is reserved for selected patients with sufficient stenosis, high-risk imaging features, adequate life expectancy, and acceptable institutional outcomes.
JapaneseAnswer: 最適薬物療法を基盤とし、狭窄度、画像上high-risk所見、十分な期待余命、良好な施設成績を満たす選択例のみ介入する。

EnglishQuestion: How does age over 70 affect the choice of carotid stenting?
JapaneseQuestion: 70歳超は頸動脈stenting選択へどう影響するか？
EnglishAnswer: Periprocedural stroke risk with stenting is higher, so endarterectomy may be favored when otherwise appropriate.
JapaneseAnswer: Stentingの周術期stroke riskが高いため、他条件が適切ならendarterectomyを優先し得る。

EnglishQuestion: How does a distal embolic protection filter work during carotid stenting?
JapaneseQuestion: 頸動脈stenting中のdistal embolic protection filterはどう働くか？
EnglishAnswer: It is deployed distal to the stenosis, preserves blood flow, captures plaque debris, and is then retrieved.
JapaneseAnswer: 狭窄遠位で展開して血流を保ちながらplaque debrisを捕捉し、回収する。

EnglishQuestion: Why does an embolic protection device not eliminate stroke risk during carotid stenting?
JapaneseQuestion: Embolic protection deviceでも頸動脈stentingのstroke riskをゼロにできない理由は？
EnglishAnswer: Embolization can occur while crossing the lesion before filter deployment, and particles smaller than the filter pores may pass through.
JapaneseAnswer: Filter展開前のlesion crossingで塞栓が起こり得て、filter poreより小さいdebrisは通過し得るため。

EnglishQuestion: What anatomic alternatives to a distal filter can provide embolic protection during carotid stenting?
JapaneseQuestion: 頸動脈stentingでdistal filter以外の塞栓防御法は？
EnglishAnswer: Flow reversal or proximal protection, selected according to anatomy.
JapaneseAnswer: 解剖に応じたflow reversalまたはproximal protection。

EnglishQuestion: What is the hemodynamic sequence of subclavian steal syndrome?
JapaneseQuestion: Subclavian steal syndromeの血行動態フローは？
EnglishAnswer: Proximal subclavian stenosis lowers distal arm pressure -> ipsilateral vertebral flow reverses -> blood is drawn from the vertebrobasilar circulation to the arm -> arm exertion can reduce cerebral perfusion.
JapaneseAnswer: 椎骨動脈起始部より近位の鎖骨下動脈狭窄→遠位上肢圧低下→同側椎骨動脈逆流→vertebrobasilar circulationから上肢へ盗血→上肢運動で脳灌流低下。

EnglishQuestion: Which symptoms suggest clinically significant subclavian steal syndrome?
JapaneseQuestion: 臨床的に有意なsubclavian steal syndromeを示唆する症状は？
EnglishAnswer: Arm exertional pain, fatigue, or paresthesia together with vertebrobasilar symptoms such as dizziness or vertigo.
JapaneseAnswer: 上肢労作時疼痛、疲労、paresthesiaと、めまい・vertigoなどvertebrobasilar症状。

EnglishQuestion: Is an inter-arm systolic pressure difference or retrograde vertebral flow alone sufficient to diagnose subclavian steal syndrome?
JapaneseQuestion: 左右収縮期血圧差や椎骨動脈逆流だけでsubclavian steal syndromeと診断できるか？
EnglishAnswer: No. A difference often greater than 15 mmHg and retrograde flow must correlate with arm ischemia or vertebrobasilar symptoms.
JapaneseAnswer: できない。しばしば15 mmHg超の左右差や逆流所見と、上肢虚血・vertebrobasilar症状の対応が必要。

EnglishQuestion: Through which three mechanisms do arterial aneurysms cause harm?
JapaneseQuestion: 動脈瘤が障害を起こす3つの機序は？
EnglishAnswer: Rupture with hemorrhage, mural thrombosis with distal embolism, and mass effect on adjacent structures.
JapaneseAnswer: 破裂・出血、壁在血栓・末梢塞栓、周囲組織圧迫。

EnglishQuestion: How do true aneurysm and pseudoaneurysm differ?
JapaneseQuestion: 真性動脈瘤と仮性動脈瘤の違いは？
EnglishAnswer: A true aneurysm includes all three arterial wall layers; a pseudoaneurysm is an extravascular pulsating hematoma communicating through a disrupted vessel wall.
JapaneseAnswer: 真性動脈瘤は血管壁3層すべてを含み、仮性動脈瘤は破綻した血管壁を介して内腔と交通する血管外拍動性血腫。

EnglishQuestion: How do saccular and fusiform aneurysms differ?
JapaneseQuestion: 嚢状動脈瘤と紡錘状動脈瘤の違いは？
EnglishAnswer: A saccular aneurysm is a focal sac-like protrusion, often containing thrombus; a fusiform aneurysm is circumferential dilation.
JapaneseAnswer: 嚢状瘤はしばしば血栓を含む限局性嚢状突出、紡錘状瘤は全周性拡張。

EnglishQuestion: Which tissue abnormalities promote aneurysm formation?
JapaneseQuestion: 動脈瘤形成を促す組織異常は？
EnglishAnswer: Abnormal connective-tissue synthesis, excessive matrix degradation, and vascular smooth-muscle-cell loss.
JapaneseAnswer: 結合組織合成異常、細胞外matrix過剰分解、血管平滑筋細胞喪失。

EnglishQuestion: Where is an abdominal aortic aneurysm most commonly located?
JapaneseQuestion: 腹部大動脈瘤の好発部位は？
EnglishAnswer: Infrarenally, between the renal arteries and the aortic bifurcation.
JapaneseAnswer: 腎動脈下から大動脈分岐部上。

EnglishQuestion: Which factors increase the risk of abdominal aortic aneurysm?
JapaneseQuestion: 腹部大動脈瘤の危険因子は？
EnglishAnswer: Smoking, age over 60 years, male sex, family history, and atherosclerosis.
JapaneseAnswer: 喫煙、60歳超、男性、家族歴、動脈硬化。

EnglishQuestion: What triad suggests ruptured abdominal aortic aneurysm?
JapaneseQuestion: 腹部大動脈瘤破裂を示唆する3徴は？
EnglishAnswer: Acute abdominal or back pain, a pulsatile abdominal mass, and hypotension.
JapaneseAnswer: 急性腹・背部痛、拍動性腹部腫瘤、低血圧。

EnglishQuestion: How do intraperitoneal and retroperitoneal AAA rupture typically differ clinically?
JapaneseQuestion: 腹腔内破裂と後腹膜破裂の臨床経過の違いは？
EnglishAnswer: Intraperitoneal rupture often causes immediate circulatory collapse; retroperitoneal rupture may be temporarily contained but can progress to shock.
JapaneseAnswer: 腹腔内破裂は突然の循環虚脱を起こしやすく、後腹膜破裂は一時的に被包されてもshockへ進み得る。

EnglishQuestion: Which limb manifestations can result from thrombus and embolism in abdominal aortic aneurysm?
JapaneseQuestion: 腹部大動脈瘤内血栓・塞栓が起こす下肢症状は？
EnglishAnswer: Claudication, blue toe syndrome, and a painful cold pulseless limb.
JapaneseAnswer: Claudication、blue toe、疼痛・冷感を伴うpulseless limb。

EnglishQuestion: Which imaging tests diagnose abdominal aortic aneurysm?
JapaneseQuestion: 腹部大動脈瘤の診断画像は？
EnglishAnswer: Ultrasonography and CT.
JapaneseAnswer: 超音波とCT。

EnglishQuestion: How is an asymptomatic abdominal aortic aneurysm managed before the repair threshold is reached?
JapaneseQuestion: 修復閾値未満の無症候性腹部大動脈瘤はどう管理するか？
EnglishAnswer: Surveillance plus blood pressure control, smoking cessation, statin therapy, and management of other atherosclerotic indications; antiplatelet therapy is not prescribed solely because an aneurysm is present.
JapaneseAnswer: 画像surveillance、降圧、禁煙、statin、他の動脈硬化適応の管理を行い、動脈瘤だけを理由に抗血小板薬を一律投与しない。

EnglishQuestion: What abdominal aortic aneurysm diameters generally indicate elective repair in men and women?
JapaneseQuestion: 腹部大動脈瘤の待機的repairを行う一般的径基準は？
EnglishAnswer: At least 5.5 cm in men and at least 5.0 cm in women.
JapaneseAnswer: 男性5.5 cm以上、女性5.0 cm以上。

EnglishQuestion: How do open AAA repair and EVAR exclude an aneurysm from circulation?
JapaneseQuestion: Open AAA repairとEVARはどう瘤を循環から除外するか？
EnglishAnswer: Open repair clamps and opens the aneurysm and sutures in a prosthetic graft; EVAR leaves the sac in place and seals a stent-graft proximally and distally to redirect flow through a new lumen.
JapaneseAnswer: Open repairは大動脈をclampし瘤壁を開いて人工血管を縫着し、EVARは瘤を切除せず近位・遠位sealing zoneでstent-graft内へ血流を通す。

EnglishQuestion: Which major complications occur after open abdominal aortic aneurysm repair?
JapaneseQuestion: Open腹部大動脈瘤repair後の主な合併症は？
EnglishAnswer: Bleeding, thrombosis, graft infection, and myocardial infarction.
JapaneseAnswer: 出血、血栓、graft感染、心筋梗塞。

EnglishQuestion: Which major complications occur after EVAR?
JapaneseQuestion: EVAR後の主な合併症は？
EnglishAnswer: Endoleak, device migration, renal injury, and access-site bleeding or infection.
JapaneseAnswer: Endoleak、device migration、腎障害、access部出血・感染。

EnglishQuestion: Why is lifelong imaging surveillance required after EVAR?
JapaneseQuestion: EVAR後に継続的画像surveillanceが必要な理由は？
EnglishAnswer: Endoleak can repressurize and enlarge the aneurysm sac despite the stent-graft.
JapaneseAnswer: Endoleakによりstent-graft外のaneurysm sacが再加圧・拡大し得るため。

EnglishQuestion: Which segments should be distinguished when evaluating a thoracic aortic aneurysm?
JapaneseQuestion: 胸部大動脈瘤評価で区別するsegmentは？
EnglishAnswer: The aortic root, ascending aorta, arch, and descending thoracic aorta.
JapaneseAnswer: 大動脈基部、上行大動脈、弓部、下行胸部大動脈。

EnglishQuestion: Which conditions are associated with root or ascending thoracic aneurysm versus descending thoracic aneurysm?
JapaneseQuestion: 基部・上行胸部大動脈瘤と下行胸部大動脈瘤の関連疾患の違いは？
EnglishAnswer: Root and ascending aneurysms are associated with medial degeneration, heritable aortopathy, and bicuspid aortic valve; descending aneurysms are more strongly associated with atherosclerosis.
JapaneseAnswer: 基部・上行瘤は中膜変性、遺伝性aortopathy、二尖大動脈弁と関連し、下行瘤は動脈硬化との関連が強い。

EnglishQuestion: Which symptoms can result from thoracic aortic aneurysm compression?
JapaneseQuestion: 胸部大動脈瘤の圧迫で生じる症状は？
EnglishAnswer: Chest, back, or abdominal pain; hoarseness; hemoptysis; cough; and wheezing.
JapaneseAnswer: 胸・背・腹痛、嗄声、喀血、咳、wheezing。

EnglishQuestion: Which major complications can accompany thoracic aortic aneurysm?
JapaneseQuestion: 胸部大動脈瘤の主な合併症は？
EnglishAnswer: Aortic regurgitation from root dilation, airway or esophageal compression, thromboembolism, rupture, and dissection.
JapaneseAnswer: 大動脈基部拡張性AR、気道・食道圧迫、血栓塞栓、破裂、解離。

EnglishQuestion: How do preferred repairs differ between descending and root or ascending thoracic aortic aneurysms?
JapaneseQuestion: 下行胸部瘤と基部・上行胸部瘤でrepair法はどう異なるか？
EnglishAnswer: TEVAR is commonly used for descending thoracic aneurysms; open surgery with cardiopulmonary bypass is central for root or ascending aneurysms.
JapaneseAnswer: 下行胸部瘤ではTEVAR、基部・上行胸部瘤では人工心肺下open surgeryが中心。

EnglishQuestion: What is the most common peripheral arterial aneurysm, and what complications does it cause?
JapaneseQuestion: 最も多い末梢動脈瘤とその合併症は？
EnglishAnswer: Popliteal artery aneurysm; it can cause compression pain, acute limb ischemia, claudication, mural thrombosis, and distal embolism.
JapaneseAnswer: 膝窩動脈瘤で、圧迫痛、急性下肢虚血、claudication、瘤内血栓、末梢塞栓を起こす。

EnglishQuestion: How is an acutely thrombosed popliteal aneurysm managed initially?
JapaneseQuestion: 急性血栓化した膝窩動脈瘤の初期管理は？
EnglishAnswer: Start unfractionated heparin and urgently evaluate revascularization; use stent-graft or open bypass according to anatomy and risk.
JapaneseAnswer: 未分画heparinを開始して緊急血行再建を評価し、解剖とriskに応じstent-graftまたはopen bypassを選ぶ。

EnglishQuestion: What happens when a berry aneurysm ruptures?
JapaneseQuestion: Berry aneurysmが破裂すると何が起こるか？
EnglishAnswer: Subarachnoid hemorrhage with sudden severe headache and neck stiffness.
JapaneseAnswer: 突然の激しい頭痛と項部硬直を伴うくも膜下出血。

EnglishQuestion: What is a Charcot-Bouchard microaneurysm associated with, and where does it rupture?
JapaneseQuestion: Charcot-Bouchard microaneurysmの関連疾患と好発部位は？
EnglishAnswer: It is associated with hypertension and diabetes and commonly ruptures in the basal ganglia or thalamus, causing intracerebral hemorrhage.
JapaneseAnswer: 高血圧・糖尿病と関連し、基底核・視床で破裂して脳内出血を起こす。

EnglishQuestion: Which conditions form the acute aortic syndrome spectrum?
JapaneseQuestion: 急性大動脈症候群を構成する病態は？
EnglishAnswer: Aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aortic rupture.
JapaneseAnswer: 大動脈解離、壁内血腫、穿通性粥状硬化性潰瘍、大動脈破裂。

EnglishQuestion: Why are aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer considered a continuum?
JapaneseQuestion: 大動脈解離、壁内血腫、穿通性粥状硬化性潰瘍を連続病態とみなす理由は？
EnglishAnswer: Each is an acute aortic wall injury that can evolve into another form, pseudoaneurysm, or rupture.
JapaneseAnswer: いずれも急性大動脈壁障害で、相互移行しpseudoaneurysmや破裂へ進展し得るため。

EnglishQuestion: What creates the false lumen in aortic dissection?
JapaneseQuestion: 大動脈解離で偽腔を作る機序は？
EnglishAnswer: Blood enters the media through an intimal tear and tracks within the aortic wall.
JapaneseAnswer: 内膜裂孔から血液が中膜へ入り、大動脈壁内を進展する。

EnglishQuestion: How are Stanford A and B acute aortic dissection defined and treated initially?
JapaneseQuestion: 急性大動脈解離Stanford A・B型の定義と初期治療は？
EnglishAnswer: Type A includes any ascending aortic involvement and requires emergency open repair plus blood pressure control; type B excludes ascending involvement and begins with aggressive medical anti-impulse therapy, with endovascular treatment when indicated.
JapaneseAnswer: A型は上行大動脈を少しでも含み、降圧と緊急open repairを行う。B型は上行大動脈を含まず、厳格なanti-impulse薬物療法を基本に適応時endovascular治療を行う。

EnglishQuestion: How do DeBakey types I, II, and III map onto acute aortic dissection extent?
JapaneseQuestion: 急性大動脈解離DeBakey I・II・III型の範囲は？
EnglishAnswer: Type I extends from the ascending aorta through the arch into the descending aorta; type II is confined to the ascending aorta; type III predominantly involves the descending aorta.
JapaneseAnswer: I型は上行から弓部・下行へ連続、II型は上行に限局、III型は下行を主体とする。

EnglishQuestion: Which information should be prioritized when urgently communicating an acute aortic dissection?
JapaneseQuestion: 急性大動脈解離を緊急伝達するとき優先する情報は？
EnglishAnswer: Ascending aortic involvement and the presence of rupture or organ malperfusion, rather than only the exact tear location.
JapaneseAnswer: 裂孔位置だけでなく、上行大動脈波及と破裂・臓器malperfusionの有無。

EnglishQuestion: Which symptoms and signs should trigger suspicion of acute aortic syndrome?
JapaneseQuestion: 急性大動脈症候群を疑う症状・所見は？
EnglishAnswer: Sudden chest or back pain, blood pressure or pulse differences, syncope, dyspnea, nausea, weakness, and neurologic deficits.
JapaneseAnswer: 突然の胸・背部痛、血圧・pulse差、失神、呼吸困難、悪心、脱力、神経脱落所見。

EnglishQuestion: Which life-threatening complications can acute aortic syndrome cause?
JapaneseQuestion: 急性大動脈症候群が起こす致死的合併症は？
EnglishAnswer: Myocardial infarction, heart failure, acute limb or visceral ischemia, hemothorax, hemopericardium, cardiac tamponade, and rupture.
JapaneseAnswer: 心筋梗塞、心不全、急性下肢・内臓虚血、血胸、血性心膜液、心タンポナーデ、破裂。

EnglishQuestion: Which imaging modalities confirm and classify acute aortic syndrome?
JapaneseQuestion: 急性大動脈症候群を確定・分類する画像検査は？
EnglishAnswer: CT angiography, MR angiography, and transesophageal echocardiography.
JapaneseAnswer: CT angiography、MR angiography、経食道心エコー。

EnglishQuestion: What is the initial medical stabilization sequence in acute aortic syndrome?
JapaneseQuestion: 急性大動脈症候群の初期内科的安定化フローは？
EnglishAnswer: Monitor heart rate and blood pressure and provide analgesia -> give an intravenous beta blocker for anti-impulse therapy unless contraindicated -> add a vasodilator if hypertension persists after rate and impulse control.
JapaneseAnswer: 心拍・血圧monitoringと鎮痛→禁忌がなければ静注beta blockerでanti-impulse療法→心拍・impulse抑制後も高血圧なら血管拡張薬追加。

EnglishQuestion: What is an alternative to beta blockade when severe bronchospasm is present in acute aortic syndrome?
JapaneseQuestion: 急性大動脈症候群で重症気管支攣縮がありbeta blocker禁忌の場合の代替薬は？
EnglishAnswer: A non-dihydropyridine calcium channel blocker.
JapaneseAnswer: 非dihydropyridine系calcium channel blocker。

EnglishQuestion: How do open and endovascular repair address acute aortic pathology?
JapaneseQuestion: 急性大動脈病変に対するopen repairとendovascular repairの違いは？
EnglishAnswer: Open repair replaces diseased aorta with a prosthetic graft; endovascular repair deploys a stent-graft to exclude the lesion from blood flow.
JapaneseAnswer: Open repairは病変大動脈を人工血管で置換し、endovascular repairはstent-graftで病変を血流から除外する。

EnglishQuestion: What is an aortic intramural hematoma?
JapaneseQuestion: 大動脈壁内血腫とは？
EnglishAnswer: Hemorrhage within the aortic wall without a clearly visible entry tear.
JapaneseAnswer: 明らかなentry tearを伴わない大動脈壁内出血。

EnglishQuestion: Which settings predispose to intramural hematoma?
JapaneseQuestion: 大動脈壁内血腫の背景病態は？
EnglishAnswer: Blunt chest trauma, older age with hypertension, and penetrating atherosclerotic ulcer.
JapaneseAnswer: 鈍的胸部外傷、高齢高血圧、穿通性粥状硬化性潰瘍。

EnglishQuestion: Into which complications can an intramural hematoma progress?
JapaneseQuestion: 大動脈壁内血腫は何へ進展し得るか？
EnglishAnswer: Aortic dissection, aneurysm, or rupture.
JapaneseAnswer: 大動脈解離、動脈瘤、破裂。

EnglishQuestion: What is a penetrating atherosclerotic ulcer?
JapaneseQuestion: 穿通性粥状硬化性潰瘍とは？
EnglishAnswer: An atherosclerotic plaque ulcer that penetrates through the intima and internal elastic lamina into the media.
JapaneseAnswer: Atherosclerotic plaque潰瘍が内膜・内弾性板を越えて中膜へ達した病態。

EnglishQuestion: Which patient profile and symptoms are typical of penetrating atherosclerotic ulcer?
JapaneseQuestion: 穿通性粥状硬化性潰瘍の典型的患者像と症状は？
EnglishAnswer: An older patient with hypertension, smoking, coronary disease, or COPD who presents with severe chest, back, or abdominal pain and often elevated blood pressure.
JapaneseAnswer: 高齢で高血圧、喫煙、冠動脈疾患、COPDを背景に、強い胸・背・腹痛としばしば血圧上昇を示す。

EnglishQuestion: What is the progression sequence from atherosclerotic plaque ulceration to rupture?
JapaneseQuestion: Atherosclerotic plaque潰瘍から破裂までの進展フローは？
EnglishAnswer: Plaque ulceration limited to the intima -> penetration into the media -> intramural hematoma -> dissection, pseudoaneurysm, or rupture.
JapaneseAnswer: 内膜に限局するplaque潰瘍→中膜へpenetration→壁内血腫→解離・pseudoaneurysm・破裂。

EnglishQuestion: How is penetrating atherosclerotic ulcer treated according to complication status?
JapaneseQuestion: 穿通性粥状硬化性潰瘍は合併症の有無でどう治療するか？
EnglishAnswer: Complicated disease generally requires stent-graft repair or open surgery if endovascular treatment is unsuitable; uncomplicated disease may be managed conservatively with close imaging surveillance.
JapaneseAnswer: 合併症例はstent-graft、血管内治療不適ならopen surgeryを行い、非合併例は厳密な画像follow-up下に保存療法を選び得る。

EnglishQuestion: What is the most common cause of death before hospital arrival in type A aortic dissection?
JapaneseQuestion: A型大動脈解離の病院到着前死亡で最も多い原因は？
EnglishAnswer: Cardiac tamponade from rupture into the pericardial space.
JapaneseAnswer: 心膜腔破裂による心タンポナーデ。

EnglishQuestion: Which profiles are typical of thoracic versus infrarenal aortic rupture?
JapaneseQuestion: 胸部大動脈破裂と腎動脈下大動脈破裂の典型的患者像は？
EnglishAnswer: Thoracic rupture in younger adults is associated with Marfan or Ehlers-Danlos syndrome; infrarenal aneurysm rupture is typical in men over 50 with smoking and hypertension.
JapaneseAnswer: 若年成人の胸部破裂はMarfan・Ehlers-Danlos症候群、50歳超の喫煙・高血圧男性では腎動脈下動脈瘤破裂が典型。

EnglishQuestion: What information does Doppler ultrasonography derive from moving red blood cells?
JapaneseQuestion: Doppler超音波は移動赤血球から何を評価するか？
EnglishAnswer: The Doppler frequency shift reveals blood-flow direction and velocity.
JapaneseAnswer: Doppler周波数shiftから血流方向と速度を評価する。

EnglishQuestion: In standard color Doppler, what do red and blue flow represent?
JapaneseQuestion: 標準的color Dopplerで赤と青は何を示すか？
EnglishAnswer: Red indicates flow toward the transducer; blue indicates flow away from it.
JapaneseAnswer: 赤はtransducerへ向かう血流、青は離れる血流。

EnglishQuestion: How do pulsed-wave and continuous-wave Doppler differ?
JapaneseQuestion: PW DopplerとCW Dopplerはどう異なるか？
EnglishAnswer: Pulsed-wave Doppler selects a specific depth but aliases at high velocity; continuous-wave Doppler measures high velocities but cannot localize depth.
JapaneseAnswer: PWは深度を選択できるが高速でaliasingし、CWは高速測定できるが深度を特定できない。

EnglishQuestion: What are the main advantages of CT angiography?
JapaneseQuestion: CT血管造影の主な長所は？
EnglishAnswer: It is rapid, noninvasive, relatively inexpensive, and provides high-resolution vascular and plaque anatomy.
JapaneseAnswer: 迅速、非侵襲的、比較的安価で、血管・plaque解剖を高分解能で描出する。

EnglishQuestion: Which major vascular lesions are evaluated with CT angiography?
JapaneseQuestion: CT血管造影で評価する主要血管病変は？
EnglishAnswer: Stenosis or occlusion, aneurysm, dissection, trauma, and thrombosis or embolism.
JapaneseAnswer: 狭窄・閉塞、動脈瘤、解離、外傷、血栓・塞栓。

EnglishQuestion: What are the main advantages of MRI and MRA in vascular imaging?
JapaneseQuestion: 血管画像におけるMRI・MRAの主な長所は？
EnglishAnswer: They avoid ionizing radiation and provide strong soft-tissue, functional, and hemodynamic characterization.
JapaneseAnswer: 電離放射線を使わず、軟部組織、機能、血行動態の評価に優れる。

EnglishQuestion: What is the mechanism of late gadolinium enhancement in cardiac MRI?
JapaneseQuestion: 心臓MRIの遅延造影はどのような機序か？
EnglishAnswer: After washout from normal myocardium, gadolinium remains in expanded extracellular space within infarct scar or fibrosis, producing high signal.
JapaneseAnswer: 正常心筋からwashoutした後も梗塞瘢痕・線維化の拡大した細胞外腔にgadoliniumが残り、高信号となる。

EnglishQuestion: How should implanted devices be handled when considering MRI?
JapaneseQuestion: MRI検討時に植込みdeviceをどう扱うか？
EnglishAnswer: Do not treat all devices as absolute contraindications; verify MR compatibility, implant details, scanning conditions, and the local protocol individually.
JapaneseAnswer: 全deviceを一律禁忌とせず、MR適合性、implant情報、撮像条件、施設protocolを個別確認する。

EnglishQuestion: What is a vascular malformation?
JapaneseQuestion: 血管奇形とは何か？
EnglishAnswer: A developmental abnormality of one or more vascular systems that is present from birth, although it may become clinically apparent later.
JapaneseAnswer: 出生時から存在する単一または複数血管系の発生異常で、後年顕在化することもある。

EnglishQuestion: What defines an arteriovenous malformation?
JapaneseQuestion: 動静脈奇形を定義するものは？
EnglishAnswer: A fast-flow direct artery-to-vein connection that bypasses the capillary bed.
JapaneseAnswer: 毛細血管床を迂回する高速の動脈－静脈直接交通。

EnglishQuestion: How can a large fast-flow arteriovenous malformation cause heart failure?
JapaneseQuestion: 大きな高速流AVMはどう心不全を起こすか？
EnglishAnswer: Direct shunting increases venous return and cardiac workload, creating a risk of high-output heart failure.
JapaneseAnswer: 直接shuntが静脈還流と心仕事量を増やし、高拍出性心不全を起こし得る。

EnglishQuestion: What are common clinical manifestations of cerebral and pulmonary AVMs?
JapaneseQuestion: 脳AVMと肺AVMの主な臨床像は？
EnglishAnswer: Cerebral AVMs can cause headache, seizure, focal deficits, or intracranial hemorrhage; pulmonary AVMs cause dyspnea and impaired gas exchange.
JapaneseAnswer: 脳AVMは頭痛、痙攣、局所神経症状、頭蓋内出血、肺AVMは呼吸困難とgas exchange低下を来す。

EnglishQuestion: Which imaging findings characterize an arteriovenous malformation?
JapaneseQuestion: AVMに特徴的な画像所見は？
EnglishAnswer: Ultrasonography shows dilated arteries and veins with high flow; CT or MRI shows feeding arteries, draining veins, and rapid arteriovenous shunting.
JapaneseAnswer: 超音波で拡張動静脈と高速血流、CT・MRIで流入動脈、流出静脈、急速AV shuntを示す。

EnglishQuestion: What treatment modalities are used for symptomatic vascular malformations?
JapaneseQuestion: 症候性血管奇形に用いる治療法は？
EnglishAnswer: Sclerotherapy, catheter embolization, laser therapy, radiation, and surgical excision, selected to reduce symptoms and complications.
JapaneseAnswer: 症状・合併症軽減を目的に硬化療法、catheter塞栓、laser、放射線、外科切除を選択する。

EnglishQuestion: How do infantile hemangioma and vascular malformation differ in natural history?
JapaneseQuestion: 乳児血管腫と血管奇形は自然歴がどう異なるか？
EnglishAnswer: Hemangioma is a benign vascular tumor that proliferates rapidly in infancy and often involutes; vascular malformation is present at birth and grows slowly without spontaneous involution.
JapaneseAnswer: 血管腫は乳児期に増殖後しばしば自然退縮する良性腫瘍、血管奇形は出生時から存在し緩徐に成長して自然退縮しにくい。

EnglishQuestion: What are the major causes of renal artery stenosis or occlusion?
JapaneseQuestion: 腎動脈狭窄・閉塞の主な原因は？
EnglishAnswer: Thromboembolism, atherosclerosis, and fibromuscular dysplasia.
JapaneseAnswer: 血栓塞栓、動脈硬化、線維筋性異形成。

EnglishQuestion: How do unilateral and bilateral renal artery occlusion differ in renal consequences?
JapaneseQuestion: 片側性と両側性腎動脈閉塞は腎への影響がどう異なるか？
EnglishAnswer: In unilateral disease the opposite kidney may compensate; bilateral disease can cause acute kidney failure.
JapaneseAnswer: 片側性では対側腎が代償し得るが、両側性では急性腎不全を来し得る。

EnglishQuestion: Which findings suggest renal artery stenosis or occlusion?
JapaneseQuestion: 腎動脈狭窄・閉塞を示唆する所見は？
EnglishAnswer: Hypertension, renal bruit, worsening kidney function, flank or abdominal pain, and possible hematuria.
JapaneseAnswer: 高血圧、腎血管雑音、腎機能悪化、側腹部・腹痛、血尿。

EnglishQuestion: How is renal artery stenosis treated?
JapaneseQuestion: 腎動脈狭窄をどう治療するか？
EnglishAnswer: Control blood pressure and select patients for balloon angioplasty with or without stenting; a severely atrophic nonfunctional kidney may require nephrectomy.
JapaneseAnswer: 降圧を行い、選択例でballoon angioplasty ± stentを施行する。高度萎縮した無機能腎では腎摘を検討する。

EnglishQuestion: What is the classic presentation of acute mesenteric ischemia?
JapaneseQuestion: 急性腸間膜虚血の典型像は？
EnglishAnswer: Sudden severe abdominal pain out of proportion to the physical examination, often from superior mesenteric artery embolic occlusion.
JapaneseAnswer: 診察所見に不釣り合いな突然の激しい腹痛で、多くは上腸間膜動脈塞栓性閉塞による。

EnglishQuestion: What is the treatment sequence for acute mesenteric ischemia?
JapaneseQuestion: 急性腸間膜虚血の治療順序は？
EnglishAnswer: Resuscitate, give analgesia and broad-spectrum antibiotics, use unfractionated heparin when indicated, urgently revascularize, and resect necrotic bowel.
JapaneseAnswer: 蘇生、鎮痛、広域抗菌薬、適応に応じ未分画heparinを行い、緊急血行再建と壊死腸管切除を進める。

EnglishQuestion: What is the classic symptom triad of chronic mesenteric ischemia?
JapaneseQuestion: 慢性腸間膜虚血の典型的三徴は？
EnglishAnswer: Postprandial abdominal pain, fear of eating, and weight loss.
JapaneseAnswer: 食後腹痛、食事恐怖、体重減少。

EnglishQuestion: How is stable chronic mesenteric ischemia managed?
JapaneseQuestion: 安定した慢性腸間膜虚血をどう管理するか？
EnglishAnswer: Treat atherosclerotic risk factors and perform planned endovascular or open revascularization; routine antibiotics or anticoagulation are not the main therapy.
JapaneseAnswer: 動脈硬化riskを管理し、計画的な血管内または外科的血行再建を行う。抗菌薬・抗凝固のroutine投与は中心ではない。

EnglishQuestion: Which visceral artery aneurysm is most common, and how may rupture present?
JapaneseQuestion: 最も多い内臓動脈瘤と破裂時の所見は？
EnglishAnswer: Splenic artery aneurysm; rupture can cause acute hemodynamic instability.
JapaneseAnswer: 脾動脈瘤。破裂すると急激な血行動態不安定を来す。

EnglishQuestion: Which factors determine intervention for a visceral artery aneurysm?
JapaneseQuestion: 内臓動脈瘤の介入適応を決める因子は？
EnglishAnswer: Arterial location, true versus pseudoaneurysm, symptoms, growth, pregnancy or childbearing potential, transplant plans, and rupture risk rather than a single diameter cutoff.
JapaneseAnswer: 血管部位、真性・仮性、症状、増大、妊娠・妊娠可能性、移植予定、破裂riskで判断し、単一径だけでは決めない。

EnglishQuestion: How are solute and water removed during hemodialysis?
JapaneseQuestion: 血液透析で溶質と水分をどう除去するか？
EnglishAnswer: Small solutes are removed mainly by diffusion; water is removed mainly by transmembrane-pressure-driven ultrafiltration.
JapaneseAnswer: 小分子溶質は主に拡散、水分は主に膜間圧による限外濾過で除去する。

EnglishQuestion: Why do blood and dialysate flow countercurrently through a dialyzer?
JapaneseQuestion: dialyzer内で血液と透析液を対向流にする理由は？
EnglishAnswer: To preserve the concentration gradient along the full length of the circuit and maximize diffusion.
JapaneseAnswer: 回路全長で濃度勾配を保ち、拡散効率を最大化するため。

EnglishQuestion: What is the blood-flow sequence through an AV fistula dialysis circuit?
JapaneseQuestion: AV fistula透析回路の血流順序は？
EnglishAnswer: Blood leaves through the arterial needle, passes the roller pump and dialyzer, and returns through the venous needle.
JapaneseAnswer: arterial needleから脱血し、roller pump、dialyzerを通り、venous needleから返血する。

EnglishQuestion: How do a native AV fistula, AV graft, and central venous catheter compare?
JapaneseQuestion: native AV fistula、AV graft、中心静脈catheterを比較すると？
EnglishAnswer: A native fistula is preferred for high flow and low infection and thrombosis but needs maturation; a graft matures faster but thromboses more; a catheter is immediately usable but has low flow, infection, and venous stenosis risk.
JapaneseAnswer: native fistulaは高流量・低感染血栓だが成熟待機が必要、graftは早く使えるが血栓が多く、catheterは即時使用可だが低流量・感染・静脈狭窄riskが高い。

EnglishQuestion: Which access findings require urgent evaluation, and what should be avoided in the access arm?
JapaneseQuestion: 透析accessで緊急評価を要する所見と、access側上肢で避けることは？
EnglishAnswer: Loss or sudden change of thrill or bruit suggests thrombosis or stenosis; avoid blood draws, IV lines, blood pressure measurement, and compression when possible.
JapaneseAnswer: thrill・bruitの消失や急変は血栓・狭窄を示唆する。可能な限り採血、静脈路、血圧測定、圧迫を避ける。

EnglishQuestion: What are the main goals of endovascular treatment in acute versus chronic venous disease?
JapaneseQuestion: 急性と慢性静脈疾患で血管内治療の主目的はどう異なるか？
EnglishAnswer: In acute DVT, remove or lyse thrombus; in chronic occlusion, recanalize the venous pathway and support it with a stent to reduce post-thrombotic morbidity.
JapaneseAnswer: 急性DVTでは血栓を溶解・除去し、慢性閉塞では静脈路を再開通してstentで支持し、血栓後障害を減らす。

EnglishQuestion: What is the basic treatment for acute deep vein thrombosis?
JapaneseQuestion: 急性DVTの基本治療は？
EnglishAnswer: Anticoagulation to prevent thrombus extension and pulmonary embolism.
JapaneseAnswer: 血栓進展と肺塞栓を防ぐ抗凝固療法。

EnglishQuestion: Does anticoagulation immediately remove an existing DVT?
JapaneseQuestion: 抗凝固療法は既存DVTを直ちに除去するか？
EnglishAnswer: No. It prevents propagation and embolization while endogenous fibrinolysis acts.
JapaneseAnswer: しない。進展と塞栓を防ぎ、内因性線溶に委ねる。

EnglishQuestion: Why is systemic thrombolysis not routinely used for DVT?
JapaneseQuestion: DVTに全身血栓溶解療法をroutine使用しない理由は？
EnglishAnswer: Because of the risk of major bleeding.
JapaneseAnswer: 大出血riskがあるため。

EnglishQuestion: When is catheter-directed thrombolysis considered for acute DVT?
JapaneseQuestion: 急性DVTでcatheter-directed thrombolysisを検討するのはいつか？
EnglishAnswer: For phlegmasia or selected acute iliofemoral DVT with severe symptoms and low bleeding risk.
JapaneseAnswer: phlegmasia、または重い症状があり出血riskの低い選択された急性腸骨大腿DVT。

EnglishQuestion: How does catheter-directed thrombolysis work?
JapaneseQuestion: catheter-directed thrombolysisの手順は？
EnglishAnswer: Under fluoroscopic and contrast guidance, advance a catheter into the thrombus and deliver a thrombolytic agent locally.
JapaneseAnswer: 透視・造影下にcatheterを血栓内へ進め、血栓溶解薬を局所投与する。

EnglishQuestion: How do mechanical and aspiration thrombectomy treat venous thrombus?
JapaneseQuestion: 機械的・吸引血栓除去術は静脈血栓をどう処理するか？
EnglishAnswer: Dedicated venous devices aspirate, fragment, or retrieve the thrombus.
JapaneseAnswer: 静脈専用deviceで血栓を吸引、破砕、回収する。

EnglishQuestion: Which factors guide selection for venous thrombectomy?
JapaneseQuestion: 静脈血栓除去術の適応選択因子は？
EnglishAnswer: Anatomy, symptom severity, time since onset, bleeding risk, and institutional expertise.
JapaneseAnswer: 解剖、症状の強さ、発症時期、出血risk、施設経験。

EnglishQuestion: How does balloon angioplasty treat venous stenosis?
JapaneseQuestion: balloon angioplastyは静脈狭窄をどう治療するか？
EnglishAnswer: A deflated balloon is advanced over a guidewire to the stenosis and inflated to a defined diameter, with stenting when needed to maintain patency.
JapaneseAnswer: guidewire上で狭窄部へballoonを進めて拡張し、必要時stentを留置して開存を維持する。

EnglishQuestion: What is the anatomic lesion in May-Thurner syndrome?
JapaneseQuestion: May-Thurner症候群の解剖学的病変は？
EnglishAnswer: The right common iliac artery compresses the left common iliac vein against the spine.
JapaneseAnswer: 右総腸骨動脈が左総腸骨静脈を脊椎との間で圧迫する。

EnglishQuestion: Why does May-Thurner syndrome predispose to left iliofemoral DVT?
JapaneseQuestion: May-Thurner症候群が左腸骨大腿DVTを起こしやすい理由は？
EnglishAnswer: Compression produces left venous outflow obstruction, stasis, and an intimal spur.
JapaneseAnswer: 圧迫が左静脈流出路閉塞、うっ滞、内膜spurを生じるため。

EnglishQuestion: How is symptomatic thrombotic May-Thurner syndrome treated endovascularly?
JapaneseQuestion: 血栓を伴う症候性May-Thurner症候群を血管内治療する流れは？
EnglishAnswer: Treat the thrombus when indicated, then perform angioplasty and stent the compressed iliac vein.
JapaneseAnswer: 適応に応じ血栓処理を行い、圧迫部をangioplastyして腸骨静脈stentを留置する。

EnglishQuestion: Should asymptomatic anatomic iliac vein compression be routinely stented?
JapaneseQuestion: 無症候の腸骨静脈解剖学的圧迫をroutineにstent治療するか？
EnglishAnswer: No. Treat when symptoms, thrombosis, and imaging-confirmed outflow obstruction justify intervention.
JapaneseAnswer: しない。症状、血栓、画像上の流出路閉塞が介入を正当化する場合に治療する。

EnglishQuestion: When is recanalization and venous stenting considered for chronic iliocaval occlusion?
JapaneseQuestion: 慢性腸骨大静脈閉塞で再開通・静脈stentを検討するのはいつか？
EnglishAnswer: When symptoms or ulcers persist despite conservative care and correspond to imaging-confirmed outflow obstruction.
JapaneseAnswer: 保存療法不応の症状・潰瘍があり、画像上の流出路閉塞と対応する選択例。

EnglishQuestion: Which imaging is used for DVT diagnosis and intervention planning?
JapaneseQuestion: DVT診断と介入計画に用いる画像検査は？
EnglishAnswer: Doppler ultrasonography is first-line; CT or MR venography supports diagnosis and planning, while conventional catheter venography is now used selectively.
JapaneseAnswer: Doppler超音波が第一選択で、CT・MR静脈造影を診断・計画に用い、従来のcatheter静脈造影は選択的に行う。

EnglishQuestion: What is extracorporeal circulation?
JapaneseQuestion: 体外循環とは？
EnglishAnswer: Withdrawal of blood from the patient's circulation, processing it outside the body, and returning it to the circulation.
JapaneseAnswer: 患者の循環から血液を取り出し、体外で処理して循環へ戻すこと。

EnglishQuestion: What is the difference between the principal purposes of ECMO and cardiopulmonary bypass (CPB)?
JapaneseQuestion: ECMOと人工心肺（CPB）の主目的はどう異なるか？
EnglishAnswer: ECMO supports failing heart or lung function for a period of time; CPB replaces circulation and gas exchange during cardiac surgery and permits a motionless operative field.
JapaneseAnswer: ECMOは一定期間、低下した心肺機能を補助し、CPBは心臓手術中の循環・ガス交換を代行して静止術野を作る。

EnglishQuestion: What are representative clinical uses of ECMO?
JapaneseQuestion: ECMOの代表的な使用場面は？
EnglishAnswer: Support after cardiac surgery, bridging to heart transplantation, and cardiogenic shock.
JapaneseAnswer: 心臓手術後の補助、心臓移植までの橋渡し、心原性ショック。

EnglishQuestion: What is the blood-flow path through a basic ECMO circuit?
JapaneseQuestion: 基本的なECMO回路における血流経路は？
EnglishAnswer: Large venous drainage cannula -> pump -> membrane oxygenator -> carbon dioxide removal and oxygenation -> return to an artery in VA-ECMO or a vein in VV-ECMO.
JapaneseAnswer: 太い静脈脱血カニューレ→ポンプ→膜型人工肺→二酸化炭素除去・酸素化→VA-ECMOでは動脈、VV-ECMOでは静脈へ返血。

EnglishQuestion: How does peripheral venoarterial ECMO drain and return blood?
JapaneseQuestion: 末梢型静脈動脈ECMOはどこから脱血・送血するか？
EnglishAnswer: It drains from a large vein such as the femoral vein and returns oxygenated blood through the femoral artery retrogradely into the iliac artery and aorta.
JapaneseAnswer: 大腿静脈などの太い静脈から脱血し、酸素化血を大腿動脈から腸骨動脈・大動脈へ逆行性に送血する。

EnglishQuestion: Where is blood returned in central venoarterial ECMO?
JapaneseQuestion: 中心型静脈動脈ECMOでは血液をどこへ返すか？
EnglishAnswer: The ascending aorta.
JapaneseAnswer: 上行大動脈。

EnglishQuestion: Which functions are supported by venoarterial ECMO?
JapaneseQuestion: 静脈動脈ECMOはどの機能を補助するか？
EnglishAnswer: Both cardiac circulation and pulmonary gas exchange, thereby maintaining systemic circulation.
JapaneseAnswer: 心臓の循環機能と肺のガス交換の両方を補助し、体循環を維持する。

EnglishQuestion: How does venovenous ECMO drain and return blood, and what function does it support?
JapaneseQuestion: 静脈静脈ECMOはどこから脱血・返血し、どの機能を補助するか？
EnglishAnswer: It drains from and returns blood to the venous system and mainly supports pulmonary gas exchange.
JapaneseAnswer: 静脈系から脱血して酸素化後に静脈系へ返血し、主に肺のガス交換を補助する。

EnglishQuestion: Why must the patient's own heart provide adequate output during venovenous ECMO?
JapaneseQuestion: 静脈静脈ECMO中、患者自身の心拍出が十分である必要があるのはなぜか？
EnglishAnswer: The patient's heart must pump the oxygenated venous blood through the systemic circulation.
JapaneseAnswer: 酸素化された静脈血を患者自身の心臓が体循環へ送り出す必要があるため。

EnglishQuestion: How do venoarterial and venovenous ECMO differ?
JapaneseQuestion: 静脈動脈ECMOと静脈静脈ECMOはどう異なるか？
EnglishAnswer: VA-ECMO returns blood to the arterial system and supports circulation plus gas exchange; VV-ECMO returns blood to the venous system and mainly supports gas exchange.
JapaneseAnswer: VA-ECMOは動脈系へ返血して循環とガス交換を補助し、VV-ECMOは静脈系へ返血して主にガス交換を補助する。

EnglishQuestion: What are important advantages of ECMO?
JapaneseQuestion: ECMOの重要な利点は？
EnglishAnswer: Full circulatory support and oxygenation when VA-ECMO is used, peripheral cannulation, relatively rapid deployment, and the possibility of patient transport.
JapaneseAnswer: VA-ECMOでは完全な循環補助と酸素化が可能で、末梢カニュレーション、比較的迅速な導入、患者搬送が可能。

EnglishQuestion: What are major complications of ECMO?
JapaneseQuestion: ECMOの主な合併症は？
EnglishAnswer: Bleeding, coagulation disorders, hemolysis, thromboembolism, infection or sepsis, limb ischemia, and membrane limitations.
JapaneseAnswer: 出血、凝固障害、溶血、血栓塞栓、感染・敗血症、下肢虚血、膜寿命の制約。

EnglishQuestion: Why are both bleeding and thrombosis major problems during ECMO?
JapaneseQuestion: ECMO中に出血と血栓の両方が問題となるのはなぜか？
EnglishAnswer: Blood contacts artificial surfaces while systemic anticoagulation is required, activating coagulation and blood injury while increasing bleeding risk.
JapaneseAnswer: 血液が異物表面に接触して凝固・血液損傷が生じる一方、全身抗凝固が必要で出血リスクも増すため。

EnglishQuestion: What is the purpose of cardiopulmonary bypass during open-heart surgery?
JapaneseQuestion: 開心術中に人工心肺を用いる目的は？
EnglishAnswer: To replace circulation and oxygenation and create a motionless, bloodless field for intracardiac surgery.
JapaneseAnswer: 循環と酸素化を代行し、心内手術のため静止した無血術野を作る。

EnglishQuestion: What is the main blood-flow path through a cardiopulmonary bypass circuit?
JapaneseQuestion: 人工心肺回路の主な血流経路は？
EnglishAnswer: Venous cannula -> venous reservoir -> pump -> membrane oxygenator and heat exchanger -> arterial cannula.
JapaneseAnswer: 静脈カニューレ→静脈リザーバー→ポンプ→膜型人工肺・熱交換器→動脈カニューレ。

EnglishQuestion: Where are the venous and arterial cannulas typically placed for cardiopulmonary bypass?
JapaneseQuestion: 人工心肺で静脈・動脈カニューレを通常どこへ置くか？
EnglishAnswer: Venous cannulation is in the right atrium, venae cavae, or femoral vein; arterial return is commonly through the ascending aorta.
JapaneseAnswer: 静脈カニューレは右房、大静脈、または大腿静脈へ置き、動脈送血は通常上行大動脈から行う。

EnglishQuestion: What drives venous drainage into the cardiopulmonary bypass circuit?
JapaneseQuestion: 人工心肺回路への静脈脱血を駆動するものは？
EnglishAnswer: Gravity drainage.
JapaneseAnswer: 重力脱血。

EnglishQuestion: What do the gas blender and heater-cooler do in cardiopulmonary bypass?
JapaneseQuestion: 人工心肺のガスブレンダーと冷温水槽は何をするか？
EnglishAnswer: The gas blender supplies air and oxygen to regulate carbon dioxide removal and oxygenation; the heater-cooler controls blood temperature through the heat exchanger.
JapaneseAnswer: ガスブレンダーは空気・酸素を供給して二酸化炭素除去と酸素化を調整し、冷温水槽は熱交換器を介して血液温を制御する。

EnglishQuestion: Why is heparin given during cardiopulmonary bypass, and how is it reversed afterward?
JapaneseQuestion: 人工心肺中にヘパリンを投与する理由と、終了後の拮抗法は？
EnglishAnswer: Heparin prevents clotting in the circuit; protamine sulfate reverses its effect after bypass.
JapaneseAnswer: ヘパリンで回路内凝固を防ぎ、人工心肺終了後に硫酸プロタミンで作用を拮抗する。

EnglishQuestion: How does hypothermia protect organs during cardiopulmonary bypass?
JapaneseQuestion: 人工心肺中の低体温はどのように臓器を保護するか？
EnglishAnswer: It reduces basal metabolic rate and systemic oxygen demand, increasing tolerance to circulatory arrest or low flow.
JapaneseAnswer: 基礎代謝率と全身酸素需要を低下させ、循環停止または低灌流への耐容時間を延ばす。

EnglishQuestion: Is 28-32 degrees C a mandatory temperature range for all adult cardiopulmonary bypass procedures?
JapaneseQuestion: すべての成人人工心肺で28〜32℃が必須か？
EnglishAnswer: No. It is one example of moderate hypothermia; temperature is individualized from near normothermia to deep hypothermia according to the operation and organ-protection needs.
JapaneseAnswer: 必須ではない。中等度低体温の一例であり、手術内容と臓器保護の必要性に応じて常温付近から深部低体温まで個別化する。

EnglishQuestion: What are major indications for cardiopulmonary bypass?
JapaneseQuestion: 人工心肺の主な適応は？
EnglishAnswer: Coronary artery bypass grafting, cardiac valve repair or replacement, repair of large septal defects, and cardiac transplantation.
JapaneseAnswer: 冠動脈バイパス術、心臓弁修復・置換、大きな中隔欠損修復、心臓移植。

EnglishQuestion: What are the three major categories of acute cardiac surgical emergencies?
JapaneseQuestion: 急性心臓外科の主要な緊急病態を3つ挙げよ。
EnglishAnswer: Cardiac trauma, acute aortic dissection, and acute myocardial infarction requiring urgent coronary artery bypass grafting.
JapaneseAnswer: 心臓外傷、急性大動脈解離、緊急冠動脈バイパス術を要する急性心筋梗塞。

EnglishQuestion: How is acute Stanford type A aortic dissection treated?
JapaneseQuestion: 急性Stanford A型大動脈解離はどのように治療するか。
EnglishAnswer: It requires emergency open surgical repair, generally replacing the affected ascending aorta with a polyester graft.
JapaneseAnswer: 緊急開胸手術を行い、通常は病変のある上行大動脈を人工血管に置換する。

EnglishQuestion: How does initial management differ between uncomplicated and complicated Stanford type B aortic dissection?
JapaneseQuestion: 合併症のないStanford B型大動脈解離と合併症を伴うB型では、初期治療はどう異なるか。
EnglishAnswer: Uncomplicated type B dissection is treated with strict heart-rate and blood-pressure control plus serial imaging; complicated type B dissection requires intervention, usually TEVAR when anatomy is suitable.
JapaneseAnswer: 合併症のないB型は厳格な心拍数・血圧管理と画像フォローを行い、合併症を伴うB型は解剖学的に適応があれば通常TEVARを行う。

EnglishQuestion: What findings make Stanford type B aortic dissection complicated and indicate intervention?
JapaneseQuestion: Stanford B型大動脈解離で介入を要する「合併症あり」の所見は何か。
EnglishAnswer: Rupture, organ malperfusion, dissection progression or aortic enlargement, refractory pain, or refractory hypertension.
JapaneseAnswer: 破裂、臓器灌流障害、解離の進展または大動脈拡大、治療抵抗性疼痛、治療抵抗性高血圧。

EnglishQuestion: What is the purpose of ascending aortic replacement in acute type A aortic dissection?
JapaneseQuestion: 急性A型大動脈解離で上行大動脈置換を行う主な目的は何か。
EnglishAnswer: To exclude the proximal entry and diseased ascending aorta, preventing further extension, rupture, and cardiac tamponade.
JapaneseAnswer: 近位エントリーと病変上行大動脈を除外し、解離進展、破裂、心タンポナーデを防ぐため。

EnglishQuestion: When is urgent CABG indicated after acute myocardial infarction when PCI fails or is impossible?
JapaneseQuestion: 急性心筋梗塞でPCIが不可能または不成功の場合、緊急CABGはいつ適応となるか。
EnglishAnswer: When ischemia persists, a large amount of myocardium remains at risk, and the coronary anatomy is surgically revascularizable; it is also considered in cardiogenic shock when PCI is unsuitable.
JapaneseAnswer: 虚血が持続し、危険にさらされた心筋量が大きく、外科的血行再建が可能な場合。PCI不適応の心原性ショックでも考慮する。

EnglishQuestion: Which mechanical complications of acute myocardial infarction commonly require emergency surgery with revascularization?
JapaneseQuestion: 急性心筋梗塞のどの機械的合併症が、血行再建を伴う緊急手術を要するか。
EnglishAnswer: Papillary muscle rupture causing acute mitral regurgitation and ventricular septal rupture.
JapaneseAnswer: 急性僧帽弁逆流を来す乳頭筋断裂と心室中隔穿孔。

EnglishQuestion: Does left main or three-vessel coronary disease alone automatically indicate emergency CABG after acute myocardial infarction?
JapaneseQuestion: 急性心筋梗塞後、左主幹部病変または3枝病変だけで自動的に緊急CABGの適応となるか。
EnglishAnswer: No. The decision also depends on ongoing ischemia, myocardium at risk, feasibility of PCI, and surgical risk.
JapaneseAnswer: ならない。持続虚血、危険心筋量、PCIの実施可能性、手術リスクを併せて判断する。

EnglishQuestion: What is the immediate treatment sequence for hemodynamically unstable cardiac tamponade?
JapaneseQuestion: 血行動態が不安定な心タンポナーデの初期治療の流れは何か。
EnglishAnswer: Perform urgent image-guided pericardiocentesis for decompression, then identify and definitively treat the cause.
JapaneseAnswer: 緊急画像ガイド下心嚢穿刺で減圧し、その後に原因を特定して根本治療を行う。

EnglishQuestion: When is surgical pericardial drainage preferred over pericardiocentesis?
JapaneseQuestion: 心嚢穿刺より外科的心嚢ドレナージが優先されるのはどのような場合か。
EnglishAnswer: When the effusion is inaccessible to a needle, contains clot or pus, follows trauma or postoperative bleeding, recurs, or tissue diagnosis is needed.
JapaneseAnswer: 穿刺困難な部位、血餅や膿の存在、外傷・術後出血、再発性貯留、組織診断が必要な場合。

EnglishQuestion: Why is pericardiocentesis alone insufficient for surgical cardiac tamponade?
JapaneseQuestion: 外科的心タンポナーデで心嚢穿刺だけでは不十分なのはなぜか。
EnglishAnswer: Tamponade caused by cardiac or aortic rupture or penetrating trauma requires emergency surgery to control the source of bleeding; pericardiectomy is not routine treatment for acute tamponade.
JapaneseAnswer: 心臓・大動脈破裂や穿通性外傷では、出血源を制御する緊急手術が必要だから。心膜切除術は急性心タンポナーデの通常治療ではない。

EnglishQuestion: How do the indications for repair differ among ruptured, symptomatic unruptured, and asymptomatic abdominal aortic aneurysms?
JapaneseQuestion: 破裂性、症候性未破裂、無症候性腹部大動脈瘤では、修復術の適応はどう異なるか。
EnglishAnswer: Ruptured or suspected ruptured aneurysms require emergency repair regardless of size; symptomatic unruptured aneurysms require urgent repair; asymptomatic aneurysms are generally repaired electively at at least 5.5 cm in men or 5.0 cm in women.
JapaneseAnswer: 破裂または破裂疑いは径にかかわらず緊急修復、症候性未破裂は早急な修復、無症候性は一般に男性5.5 cm以上、女性5.0 cm以上で待機的修復を行う。

EnglishQuestion: Which abdominal aortic aneurysm features can justify early repair independent of the usual diameter threshold?
JapaneseQuestion: 通常の瘤径基準とは別に腹部大動脈瘤の早期修復を考慮する所見は何か。
EnglishAnswer: Saccular morphology, rapid expansion, or an infected aneurysm.
JapaneseAnswer: 嚢状形態、急速な拡大、感染性動脈瘤。

EnglishQuestion: What are the major causes of acute severe aortic regurgitation, and why is urgent surgery often required?
JapaneseQuestion: 急性重症大動脈弁逆流の主要原因と、緊急手術を要しやすい理由は何か。
EnglishAnswer: The major causes are infective endocarditis and ascending aortic dissection. Because the left ventricle cannot adapt to the abrupt volume load, urgent valve surgery is often required.
JapaneseAnswer: 主因は感染性心内膜炎と上行大動脈解離。左室が急激な容量負荷に適応できないため、緊急弁手術を要しやすい。

EnglishQuestion: What are the major causes and hemodynamic consequences of acute severe mitral regurgitation?
JapaneseQuestion: 急性重症僧帽弁逆流の主要原因と血行動態への影響は何か。
EnglishAnswer: Causes include infective endocarditis, chordal rupture, and post-infarction papillary muscle rupture. Abrupt regurgitation into a noncompliant left atrium causes severe pulmonary edema and may cause cardiogenic shock.
JapaneseAnswer: 原因は感染性心内膜炎、腱索断裂、心筋梗塞後乳頭筋断裂。順応していない左房への急激な逆流により重症肺水腫を来し、心原性ショックに至り得る。

EnglishQuestion: When is emergency surgery indicated for acute severe mitral regurgitation, and how is the procedure selected?
JapaneseQuestion: 急性重症僧帽弁逆流の緊急手術適応と術式選択は何か。
EnglishAnswer: Emergency repair or replacement is indicated for hemodynamic instability, refractory pulmonary edema, or shock. Repair is preferred when feasible, but replacement may be necessary after papillary muscle rupture; TEER is reserved for selected prohibitive-risk or inoperable patients after Heart Team assessment.
JapaneseAnswer: 血行動態不安定、治療抵抗性肺水腫、ショックで緊急形成術または置換術を行う。可能なら形成術を優先するが乳頭筋断裂では置換術が必要なことがあり、TEERはHeart Teamが選択した手術不能または極めて高リスク例に限る。

EnglishQuestion: What are the three major indications for surgery in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎（infective endocarditis：IE）の三大手術適応は何か？
EnglishAnswer: Heart failure, uncontrolled infection, and prevention of embolism.
JapaneseAnswer: 心不全（heart failure）、制御不能な感染（uncontrolled infection）、塞栓予防（prevention of embolism）である。

EnglishQuestion: What is the fundamental surgical principle in active infective endocarditis?
JapaneseQuestion: 活動性感染性心内膜炎（active IE）における外科治療の基本原則は何か？
EnglishAnswer: Thoroughly debride infected and necrotic tissue before assessing reconstruction.
JapaneseAnswer: 感染・壊死組織を十分にデブリードマン（debridement）してから再建可能性を評価する。

EnglishQuestion: Which valve-related conditions make heart failure or hemodynamic compromise an indication for surgery in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で心不全（heart failure）または血行動態破綻（hemodynamic compromise）を介して手術適応となる弁病変は何か？
EnglishAnswer: Significant valve stenosis or regurgitation, or prosthetic valve dysfunction.
JapaneseAnswer: 有意な弁狭窄・弁逆流、または人工弁機能不全（prosthetic valve dysfunction）である。

EnglishQuestion: What findings indicate uncontrolled infection despite appropriate antibiotic therapy in infective endocarditis?
JapaneseQuestion: 適切な抗菌薬治療（antibiotic therapy）にもかかわらず感染制御不良（uncontrolled infection）を示す所見は何か？
EnglishAnswer: Persistent positive blood cultures, relapsing infection, abscess, false aneurysm, fistula, or new atrioventricular block.
JapaneseAnswer: 血液培養陽性の持続、感染再燃、膿瘍（abscess）、仮性動脈瘤（false aneurysm）、瘻孔（fistula）、新規房室ブロック（atrioventricular block）である。

EnglishQuestion: Which factors should be integrated when deciding on surgery to prevent embolism from an infective endocarditis vegetation?
JapaneseQuestion: 感染性心内膜炎の疣贅（vegetation）による塞栓予防目的の手術判断では、どの因子を統合するか？
EnglishAnswer: Previous or recurrent embolism, vegetation size, mobility and growth, valve damage, causative organism, and surgical risk.
JapaneseAnswer: 塞栓既往・反復、疣贅の大きさ・可動性・増大、弁障害、原因菌、手術リスクを統合する。

EnglishQuestion: Does a vegetation larger than 10 mm automatically require valve replacement?
JapaneseQuestion: 10 mmを超える疣贅（vegetation）があれば一律に弁置換術（valve replacement）が必要か？
EnglishAnswer: No. Size is important, but the full embolic and surgical risk profile must be considered.
JapaneseAnswer: いいえ。大きさは重要だが、塞栓リスクと手術リスクを含む全体像で判断する。

EnglishQuestion: Which features of prosthetic valve endocarditis favor surgical treatment?
JapaneseQuestion: 人工弁心内膜炎（prosthetic valve endocarditis：PVE）で外科治療を支持する所見は何か？
EnglishAnswer: Heart failure, severe prosthetic dysfunction, perivalvular extension such as abscess, persistent infection, relapse, or early PVE within six months after valve surgery.
JapaneseAnswer: 心不全、重度人工弁機能不全、膿瘍などの弁周囲進展、感染持続、再燃、または弁手術後6か月以内の早期PVEである。

EnglishQuestion: Why does prosthetic valve endocarditis not mandate the same surgical timing and procedure in every patient?
JapaneseQuestion: 人工弁心内膜炎（PVE）で全患者に同じ手術時期・術式を適用しないのはなぜか？
EnglishAnswer: Because timing and procedure depend on complications, infection control, valve dysfunction, and individualized Endocarditis Team assessment.
JapaneseAnswer: 合併症、感染制御、人工弁機能不全の程度が異なるため、心内膜炎チーム（Endocarditis Team）が個別に判断する。

EnglishQuestion: What is the preferred operation for mitral or tricuspid infective endocarditis when durable reconstruction is possible?
JapaneseQuestion: 僧帽弁または三尖弁の感染性心内膜炎で耐久性のある再建が可能な場合、優先する術式は何か？
EnglishAnswer: Competent valve repair is preferred over valve replacement.
JapaneseAnswer: 十分な弁機能が得られる弁形成術（valve repair）を弁置換術（valve replacement）より優先する。

EnglishQuestion: When may aortic root replacement be required in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で大動脈基部置換術（aortic root replacement）が必要となり得るのはどのような場合か？
EnglishAnswer: When aortic valve infective endocarditis is complicated by an annular abscess and extensive root destruction.
JapaneseAnswer: 大動脈弁感染性心内膜炎に弁輪膿瘍（annular abscess）と広範な大動脈基部破壊を伴う場合である。

EnglishQuestion: What is performed when an infected valve cannot be repaired after adequate debridement?
JapaneseQuestion: 十分なデブリードマン（debridement）後も感染弁を修復できない場合、何を行うか？
EnglishAnswer: Valve replacement with a mechanical or bioprosthetic valve.
JapaneseAnswer: 機械弁（mechanical valve）または生体弁（bioprosthetic valve）による弁置換術を行う。

EnglishQuestion: Which factors guide the choice between a mechanical and bioprosthetic valve in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で機械弁（mechanical valve）と生体弁（bioprosthetic valve）を選択する際の判断因子は何か？
EnglishAnswer: Age, feasibility of anticoagulation, bleeding risk, medication adherence, and future reoperation risk.
JapaneseAnswer: 年齢、抗凝固療法の可否、出血リスク、服薬継続性、将来の再手術リスクである。

EnglishQuestion: Does active infection alone determine the type of prosthetic valve used for replacement?
JapaneseQuestion: 活動性感染（active infection）だけで置換する人工弁の種類を一律に決めるか？
EnglishAnswer: No. Prosthesis selection must be individualized.
JapaneseAnswer: いいえ。人工弁の選択は患者ごとに個別化する。

EnglishQuestion: Should surgery be routinely postponed until completion of antibiotic therapy once a surgical indication is established?
JapaneseQuestion: 手術適応が成立した感染性心内膜炎では、抗菌薬治療（antibiotic therapy）の完了まで一律に手術を延期するか？
EnglishAnswer: No. Necessary surgery should not be delayed solely to complete the antibiotic course.
JapaneseAnswer: いいえ。抗菌薬投与期間を完了することだけを理由に必要な手術を延期しない。

EnglishQuestion: When is emergency surgery within approximately 24 hours indicated in left-sided infective endocarditis?
JapaneseQuestion: 左心系感染性心内膜炎で、おおむね24時間以内の緊急手術（emergency surgery）が適応となるのはいつか？
EnglishAnswer: When aortic or mitral regurgitation, obstruction, or fistula causes refractory pulmonary edema or cardiogenic shock.
JapaneseAnswer: 大動脈弁または僧帽弁の逆流、閉塞、瘻孔が治療抵抗性肺水腫（refractory pulmonary edema）または心原性ショック（cardiogenic shock）を来した場合である。

EnglishQuestion: When should urgent surgery within approximately three to five days be considered in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で、おおむね3〜5日以内の準緊急手術（urgent surgery）を検討するのはいつか？
EnglishAnswer: For aortic or mitral infective endocarditis with heart failure, or signs of uncontrolled local infection such as abscess, false aneurysm, fistula, enlarging vegetation, or new atrioventricular block.
JapaneseAnswer: 大動脈弁・僧帽弁感染性心内膜炎による心不全、または膿瘍、仮性動脈瘤、瘻孔、増大する疣贅、新規房室ブロックなど局所感染制御不良の所見がある場合である。

EnglishQuestion: How is tricuspid regurgitation due to infective endocarditis usually managed initially?
JapaneseQuestion: 感染性心内膜炎による三尖弁逆流（tricuspid regurgitation）は通常どのように初期管理するか？
EnglishAnswer: Medical management is usually the main approach.
JapaneseAnswer: 通常は内科的治療（medical management）を中心とする。

EnglishQuestion: What should be suspected when infective endocarditis persists or relapses despite appropriate antibiotics?
JapaneseQuestion: 適切な抗菌薬にもかかわらず感染性心内膜炎が持続または再燃する場合、何を疑うか？
EnglishAnswer: A resistant organism or abscess formation.
JapaneseAnswer: 耐性菌（resistant organism）または膿瘍形成（abscess formation）を疑う。

EnglishQuestion: What surgical step should be considered for persistent or relapsing infective endocarditis when no extracardiac infectious focus is found?
JapaneseQuestion: 感染性心内膜炎が持続・再燃し、心外感染巣（extracardiac infectious focus）が見つからない場合、何を検討するか？
EnglishAnswer: Valve replacement should be considered.
JapaneseAnswer: 弁置換術（valve replacement）を検討する。

EnglishQuestion: Which mechanical complications of infective endocarditis are indications for early surgery?
JapaneseQuestion: 感染性心内膜炎で早期手術（early surgery）の適応となる機械的合併症は何か？
EnglishAnswer: High-degree atrioventricular block, interventricular septal perforation, rupture of a sinus of Valsalva aneurysm into the right ventricle, and intracardiac abscess.
JapaneseAnswer: 高度房室ブロック（high-degree atrioventricular block）、心室中隔穿孔、バルサルバ洞動脈瘤の右室内破裂、心腔内膿瘍（intracardiac abscess）である。

EnglishQuestion: Why is a new high-degree atrioventricular block an alarming sign in infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で新規高度房室ブロック（high-degree atrioventricular block）が警告所見となるのはなぜか？
EnglishAnswer: It may indicate extension of infection into the perivalvular tissue with abscess formation.
JapaneseAnswer: 感染が弁輪周囲組織へ進展し、膿瘍を形成している可能性を示すためである。

EnglishQuestion: What is the operative sequence after early surgery is selected for infective endocarditis?
JapaneseQuestion: 感染性心内膜炎で早期手術（early surgery）を選択した後の手術の流れは何か？
EnglishAnswer: Thoroughly debride infected tissue, assess the remaining valve and annular damage, then perform valve repair, valve replacement, or root replacement as required.
JapaneseAnswer: 感染組織を十分にデブリードマンし、残存する弁・弁輪損傷を評価して、必要に応じ弁形成、弁置換、または大動脈基部置換を行う。

EnglishQuestion: How does an annular abscess affect surgery for infective endocarditis?
JapaneseQuestion: 弁輪膿瘍（annular abscess）は感染性心内膜炎の手術にどのような影響を与えるか？
EnglishAnswer: It makes surgery technically more difficult and may require extensive reconstruction.
JapaneseAnswer: 手術を技術的に難しくし、広範な再建を必要とすることがある。

EnglishQuestion: Can a decompensated patient with infective endocarditis still benefit from surgery?
JapaneseQuestion: 非代償状態（decompensated state）の感染性心内膜炎患者でも手術の利益を得られるか？
EnglishAnswer: Yes, but operative mortality is high.
JapaneseAnswer: 得られる可能性はあるが、手術死亡率（operative mortality）は高い。