酷似急性心肌梗死的应激性心肌病20例误诊分析  

Analysis of 20 Patients with Stress Cardiomyopathy Presented with Acute Myocardial Infarction and a Literature Review

作　　者：杨婧[1] 李俊杰[1] 虎晓岷[1] 黄杨[1] 尹文[1] YANG Jing LI Jun-jie HU Xiao-min HUANG Yang YIN Wen(Emergency Department, Xijing Hospital, the Fourth Military Medical University of PLA, Xi＇an 710032, China)

机构地区：[1]第四军医大学西京医院急诊科,西安710032

出　　处：《临床误诊误治》2016年第10期22-25,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨应激性心肌病(stress cardiomyopathy,SCM)的临床特点、诊疗方法及误诊原因。方法回顾性分析西京医院2009年5月—2015年7月诊治的20例SCM患者临床资料。结果 20例均以胸痛、胸闷为主诉就诊,19例有明显的心理应激诱发因素,伴有心悸、气短、出汗、黑蒙和晕厥等。心电图均表现多导联ST段抬高,其中13例出现T波倒置,5例出现QT间期延长,2例出现病理性Q波。查心肌损伤标志物轻度升高。20例初步诊断为急性心肌梗死,后上级医师查房发现多数患者发病前有明显心理应激史;有新发的心电图异常表现;发病后24 h内冠状动脉造影示无明显狭窄性病变及急性斑块破裂征象;左心室造影示左心室壁运动功能障碍范围超过单支冠状动脉供血范围,遂修正诊断为SCM。及时调整治疗方案,预后良好。结论 SCM表现极似急性心肌梗死,易误诊;及时行心脏超声、冠状动脉造影及左心室造影,有助于早期确诊并治疗。Objective To investigate clinical characteristics, diagnosis and treatment methods and misdiagnosed causes of stress cardiomyopathy （SCM）. Methods Clinical data of 20 SCM patients during May 2009 and July 2015 was retrospectively analyzed. Results The 20 patients visited doctors for chest pain and dyspnea, 19 patients had obvious causative factor of psychological stress, and all patients were accompanied by palpitation, shortness of breath, sweating, amaurosis and syncope. ECG examination showed muti lead ST segment elevation, which included 13 patients with T wave inversion, 5 patients with QT interval prolongation and 2 patients with pathological Q wave. Examinations of myocardial damage markers showed slightly elevated. Primary diagnosis was acute myocardial infarction （AMI） for the 20 patients, and then pathogenetic conditions analysis showed that most of them had history of psychological stress and newly finding abnormal ECG; no obvious stenosis lesion or acute plaque breaking was found by ventriculography within 24 h pathogenesy ; ventriculography of left ventricle showed that range of left ventricular wall motor dysfunction exceeded blood-supply by one coronary artery. The SCM was confirmed. Treatment protocols were adjusted after confirming SCM. All patients had good prognosis. Conclusion SCM clinical manifestation is very similar to acute myocardial infarction, and therefore SCM is easy to be misdiagnosed. Timely performing echocardiography, coronary arteriongraphy and ventriculography of left ventricle are helpful for clinicians to confirm final diagnosis and treatment early.

关 键 词：心肌疾病 误诊 心肌梗死 心脏超声 心室造影 

分 类 号：R542.2[医药卫生—心血管疾病]