误诊为急性肝功能衰竭的心脏疾病临床分析
Clinical Analysis of Cardiac Diseases Misdiagnosed as Acute Liver Failure
郭声 1刘长虹 1刘颖 1廖燕 1魏应凤2
作者信息
- 1. 341000 江西赣州,赣州市第五人民医院重症肝病科肝病研究所
- 2. 341000 江西赣州,赣州市人民医院消化内科
- 折叠
摘要
目的 探讨误诊为急性肝功能衰竭的心脏疾病的临床特点及误诊原因,并总结防范措施.方法 回顾性分析2021 年4 月—2022 年8 月收治的3 例初诊误诊为急性肝功能衰竭的心脏疾病的临床资料.结果 本文 3 例分别因乏力、胸闷、心悸和肝功能异常;胸闷,加重伴食欲不振、乏力;无明显诱因气促、胸闷,伴咳嗽、咳痰,乏力、食欲减退,双下肢水肿就诊.经相关生化检查,初诊皆误诊为急性肝功能衰竭.后1 例经心脏彩色多普勒超声检查诊断心脏瓣膜病伴心房颤动、急性心功能不全,2 例经心脏彩色多普勒超声和心包穿刺检查诊断肺恶性肿瘤继发恶性心包积液、心包填塞.3 例皆予相应治疗症状缓解后行进一步治疗.结论 当患者以乏力、胸闷、肝功能异常、凝血功能障碍等类似肝功能衰竭表现就诊时,需考虑到心脏疾病可能.临床医师应熟练掌握心脏疾病与肝功能衰竭的诊断及鉴别诊断要点,详细询问病史,重视体格检查,并尽早完善相关医技检查,以提高诊断准确率,减少或避免误诊误治.
Abstract
Objective To investigate the clinical characteristics and causes of misdiagnosis of heart disease as acute liver failure,and to summarize preventive measures.Methods The clinical data of 3 patients with heart disease who were in-itially misdiagnosed as acute liver failure from April 2021 to August 2022 were retrospectively analyzed.Results One patient presented with fatigue,chest tightness,palpitation and abnormal liver function,one patient presented with chest tightness which was aggravated with loss of appetite,fatigue,and one patient presented with shortness of breath and chest tightness with no obvious triggers,accompanied by cough,sputum,fatigue,loss of appetite,edema of both lower limbs.After the relevant biochemical examination,the initial diagnosis was misdiagnosis as acute liver failure.Afterwards,1 patient was diagnosed with valvular heart disease with atrial fibrillation and acute cardiac insufficiency by color Doppler echocardiography,and 2 pa-tients were diagnosed with malignant pericardial effusion and pericardial tamponade secondary to pulmonary malignancy by col-or Doppler echocardiography and pericardiocentesis.All 3 patients were given further treatment after symptoms were relieved.Conclusion The possibility of heart disease should be considered when patients present with symptoms similar to liver fail-ure,such as fatigue,chest tightness,abnormal liver function,and coagulation dysfunction.Clinicians should be proficient in the diagnosis and differential diagnosis of heart disease and liver failure,inquire about the medical history in detail,pay atten-tion to physical examination,and perform the relevant examination as soon as possible,so as to improve the diagnostic accura-cy,and reduce or avoid misdiagnosis and treatment.
关键词
心脏疾病/心脏瓣膜疾病/心包积液/误诊/肝功能衰竭/超声检查,多普勒,彩色/心包穿刺术Key words
Cardiac disease/Heart valve diseases/Pericardial effusion/Misdiagnosis/Liver failure/Ultrasonogra-phy,doppler,color/Pericardiocentesis引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据