中青年不典型急性心肌梗死七例误诊分析  

Analysis of Misdiagnosed 7 Young and Middle-aged Patients with Atypical Acute Myocardial Infarction

作　　者：张少利[1] 李燕[1] 王学惠[1] 陈志刚[1] 

机构地区：[1]新乡医学院第一附属医院心内三科,河南卫辉453100

出　　处：《临床误诊误治》2017年第4期50-51,共2页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨中青年急性心肌梗死(acute myocardial infarction,AMI)的不典型表现及误诊原因,降低误诊率。方法回顾性分析2015年5月—2016年2月我院收治的7例中青年不典型AMI误诊病例资料。结果本组年龄24~44岁。2例因上腹疼痛、恶心、呕吐、呃逆、腹泻等消化道症状误诊为急性胃肠炎;1例因咳嗽、咳痰、气促,X线胸片示肺纹理增粗误诊为支气管炎;1例因单纯胸痛误诊为肋间神经炎;1例因心悸、乏力、心电图ST段压低误诊为心脏神经症;1例因头昏、双上肢无力及腔隙性脑梗死病史误诊为脑梗死;1例因低血压、体位改变后晕厥误诊为体位性晕厥。本组平均误诊时间(4.56±1.26)d,按误诊疾病治疗效果不佳,后行心电图检查发现动态改变,查心肌酶谱异常,确诊为AMI。确诊后予再灌注治疗,病情稳定后出院。结论复杂多样化及不典型的临床表现极易导致中青年AMI误诊,临床医师应提高对中青年AMI的警惕性,减少误诊误治。Objective To investigate atypical manifestations and misdiagnosed causes of young and middle-aged patients with atypical acute myocardial infarction （AMI） in order to reduce misdiagnosis rate.Methods Clinical data of 7 young and middle-aged patients with atypical AMI admitted during May 2015 and February 2016 was retrospectively analyzed.Results The range of patients were from 24 to 44 years old.A total of 2 patients were misdiagnosed as having acute gastroenteritis due to gastrointestinal symptoms such as abdominal pain, nausea, vomiting, hiccups, diarrhea;1 patient was misdiagnosed as having bronchitis due to cough, expectoration, shortness of breath and thickening lung markings by chest X-ray;1 patient was misdiagnosed as having intercostal neuritis due to simple chest pain;1 patient was misdiagnosed as having cardiac neuropathy due to palpitations, fatigue and ST segment depression by electrocardiogram （ECG）;1 patient was misdiagnosed as having cerebral infarction due to dizziness, both upper extremities powerless and lacunar infarction history;1 patient was misdiagnosed as having postural syncope due to hypotension and syncope.The average time of misdiagnosis was （4.56±1.26）d.The effects of symptomatic treatment for misdiagnosed diseases were poor, and dynamic changes were found after ECG examination, and then AMI was confirmed after finding abnormal result of myocardial enzyme examination.Reperfusion therapy was given after confirming AMI, and patients were discharged after having stable conditions.Conclusion Complex and atypical manifestations can easily lead to misdiagnosis for young and middle-aged patients with AMI, so clinicians should improve the vigilance of young and middle-aged patients with AMI so as to avoid misdiagnosis and mistreatment.

关 键 词：心肌梗死 中青年 误诊 胃肠炎 支气管炎 

分 类 号：R542.22[医药卫生—心血管疾病]