摘要
目的探讨不典型急性心肌梗死(AMI)早期心电图误诊原因及防范措施。方法回顾分析2022年1月—2023年2月收治的曾误诊的不典型AMI 2例的临床资料。结果1例因发热、胸闷、心悸、咳嗽和全身乏力1 d就诊,心电图检查示Ⅱ、Ⅲ、aVF导联ST段压低,T波低平,窦性心律不齐,误诊为心肌炎,予对症治疗无好转,复查心电图及心肌酶等后诊断为AMI。1例因胸痛、晕厥倒地2 h入院,心电图无ST-T及异常Q波改变,提示右心室肥大,诊断为右心室肥大,后经心肌酶、心脏超声及冠状动脉造影检查明确诊断AMI。误诊时间3 d和6 h。1例行药物保守治疗,1例行经皮冠状动脉介入术治疗,随访均预后良好。结论不典型AMI患者或因无明显胸痛症状,或因早期心电图表现不典型或正常,导致初期极易误诊。加强对不典型AMI认识,对伴有高危因素者提高警惕性,熟知其心电图动态变化特点,注重动态心电图监测,并结合临床症状及心肌酶情况综合分析病情,有助于早期确诊并治疗。
Objective To investigate the causes and preventive measures of early Electrocardiogram(ECG)misdiagnosis of atypical acute myocardial infarction(AMI).Methods The clinical data of 2 patients with misdiagnosed atypical AMI admitted from January 2022 to February 2023 were retrospectively analyzed.Results One patient presented with fever,chest tightness,palpitation,cough and general fatigue for 1 d.ECG showed ST segment depression in leadsⅡ,Ⅲand aVF,with low and flat T waves and sinus arrhythmia,and it was misdiagnosed as myocarditis.The patient was treated symptomatically without improvement,and AMI was diagnosed after reexamination of ECG and myocardial enzyme.One patient was admitted to hospital for chest pain and syncope for 2 h.No ST-T or abnormal Q-wave changes were found in the ECG,and right ventricular hypertrophy was suggested.AMI was confirmed by myocardial enzyme,cardiac ultrasound and coronary angiography.The duration of misdiagnosis was 3 d and 6 h.One patient received conventional medication treatment,and one patient underwent percutaneous coronary intervention.The prognosis was good after operation.Conclusion It is more likely to misdiagnose patients with atypical AMI because there is no obvious symptom of chest pain nor typical manifestations or normal manifestations in early stage on ECG.Strengthening the understanding of atypical AMI,being alert to the patients with high risk factors,being familiar with the characteristics of dynamic changes of ECG,paying attention to monitoring of dynamic ECG,and combining clinical symptoms and myocardial enzymes to analyze the condition are helpful for early diagnosis and treatment.
作者
邓正超
李兴明
陈德华
DENG Zhengchao;LI Xingming;CHEN Dehua(Department of Electrocardiogram Room,the People's Hospital of Zizhong,Zizhong,Sichuan 641000,China;Department of Respiratory and Critical Care Medicine,the People's Hospital of Zizhong,Zizhong,Sichuan 641000,China;Department of Respiratory and Critical Care Medicine,the First People's Hospital of Neijiang,Neijiang,Sichuan 641000,China)
出处
《临床误诊误治》
CAS
2024年第8期1-4,共4页
Clinical Misdiagnosis & Mistherapy
基金
四川省卫生健康委员会科研课题(20PJ321)。
关键词
心肌梗死
心电图
误诊
心肌炎
心室肥大
心肌酶
冠状血管造影术
诊断
Myocardial Infarction
Electrocardiogram
Misdiagnosis
Myocarditis
Ventricular hypertrophy
Myocardial enzymes
Coronary angiography
Diagnosis
