摘要
目的探讨误诊为急性心肌梗死(AMI)的主动脉夹层(AD)的临床特点、鉴别诊断要点及误诊原因、防范措施。方法回顾性分析误诊为AMI的AD 8例的临床资料,并结合国内外文献进行分析。结果本组8例均为男性,有高血压病史6例,皆以胸痛为主要症状,D-二聚体明显升高,心电图有明显ST-T改变。5例误诊为急性ST段抬高型心肌梗死,3例误诊为急性非ST段抬高型心肌梗死。误诊时间平均11 h。8例经AMI相关治疗后效果均欠佳,皆经主动脉CT血管造影检查确诊为AD,给予相应治疗。经治疗后好转3例,死亡5例。结论AD以急性胸痛为主要症状并伴心电图ST-T改变时,易误诊为AMI。临床医生应提高警惕,注意上述2种疾病的鉴别诊断要点,详细问诊及仔细查体,并尽早采取有效影像学检查,以减少或避免AD误诊误治。
Objective To investigate the clinical characteristics,differential diagnosis,causes of misdiagnosis and preventive measures of aortic dissection(AD)misdiagnosed as acute myocardial infarction(AMI).Methods The clinical data of 8 patients with AD misdiagnosed as AMI were analyzed retrospectively combined with the literature at home and abroad.Results All 8 patients were males,and 6 had history of hypertension.Chest pain was the main symptom,D-dimer was significantly elevated,and ECG showed significant ST-T changes.Five patients were misdiagnosed as acute ST-segment elevation myocardial infarction(STEMI)and 3 as acute non-STEMI.The mean duration of misdiagnosis was 11 h.All 8 patients were diagnosed with AD by CT angiography of aorta after ineffective AMI-related treatment.Corresponding treatment was provided.After treatment,3 patients improved and 5 died.Conclusion When the main symptom of AD is acute chest pain with ECG ST-T changes,it is more likely to be misdiagnosed as AMI.Clinician should be vigilant,pay attention to the differential diagnosis of the above two diseases,conduct detailed consultation and careful physical examination,and take effective imaging examinations as soon as possible to reduce or avoid misdiagnosis and mistreatment of AD.
作者
高磊
张刘燕
冷燕侠
顾君
肖建强
GAO Lei;ZHANG Liuyan;LENG Yanxia;GU Jun;XIAO Jianqiang(Department of Cardiovascular Diseases,Wujin Hospital Affiliated to Jiangsu University Wujin Clinical College of Xuzhou Medical University,Changzhou,Jiangsu 213002,China)
出处
《临床误诊误治》
CAS
2023年第12期1-5,共5页
Clinical Misdiagnosis & Mistherapy
基金
常州市武进区科技计划发展项目(WS202005)。
关键词
动脉瘤
夹层
误诊
心肌梗死
胸痛
心电图
ST-T改变
血管造影术
体层摄影术
螺旋计算机
Aneurysm,dissecting
Misdiagnosis
Myocardial infarction
Chest pain
Electrocardiogram
ST-T changes
Angiography
Tomography,spiral computed
