不典型急性心肌梗死心电图误诊分析
Analysis of ECG Misdiagnosis of Atypical Acute Myocardial Infarction
邓正超 1李兴明 2陈德华3
作者信息
- 1. 641000 四川资中,资中县人民医院心电图室
- 2. 641000 四川内江,内江市第一人民医院呼吸与危重症医学科
- 3. 641000 四川资中,资中县人民医院呼吸与危重症医学科
- 折叠
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 1d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2h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3d和6h.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.
Abstract
Objective To investigate the causes and preventive measures of early Electrocardiogram(ECG)misdiag-nosis 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 symptomati-cally without improvement,and AMI was diagnosed after reexamination of ECG and myocardial enzyme.One patient was ad-mitted 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 angiogra-phy.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 mis-diagnose 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.
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Key words
Myocardial Infarction/Electrocardiogram/Misdiagnosis/Myocarditis/Ventricular hypertrophy/Myocar-dial enzymes/Coronary angiography/Diagnosis引用本文复制引用
基金项目
四川省卫生健康委科研项目(20PJ321)
出版年
2024
国家科技期刊平台
NSTL
万方数据