以头晕为首发症状的急性心肌梗死误诊原因探析  

Misdiagnosed Causes of Acute Myocardial Infarction with Dizziness as the Initial Symptom

作　　者：周世方[1] 杨志伟[1] 李长罗[1] ZHOU Shi-fang;YANG Zhi-wei;LI Chang-luo(Emergency Department,Changsha Central Hospital,Changsha 410004,China)

机构地区：[1]长沙市中心医院急诊科,长沙410004

出　　处：《临床误诊误治》2021年第9期5-8,共4页Clinical Misdiagnosis & Mistherapy

基　　金：湖南省卫生健康委课题(20201088)。

摘　　要：目的探讨以头晕为首发症状的急性心肌梗死发病机制及误诊原因、防范措施。方法回顾性分析2017年5月—2021年1月收治的曾误诊的以头晕为首发症状急性心肌梗死6例的临床资料。结果本组均以头晕为主诉,发病后在当地医疗机构(4例)及我院(2例)急诊就诊,误诊为后循环缺血4例,肺炎和高血压急症各1例。误诊时间1~48 h。6例按误诊疾病给予相应治疗均无效,进一步回顾分析病史、临床表现和相关检查结果结合相关诊断标准确诊为急性心肌梗死。后6例皆急诊行经皮冠状动脉介入治疗,均放置支架,病情好转后出院。随访1个月~3年,1例死亡,5例预后良好。结论以头晕为首发症状的急性心肌梗死临床易误诊。详细病史询问并认真查体、拓展诊断思维、及时完善相关检查,以及加强心电图知识学习或可减少或避免其误诊误治。Objective To explore the pathogenesis,misdiagnosed causes and preventive measures of acute myocardial infarction(AMI)with dizziness as the initial symptom.Methods Clinical data of 6 patients with AMI with dizziness as the initial symptom admitted between May 2017 and January 2021 was retrospectively analyzed.Results Dizziness was the main complaint in all 6 patients.After the onset of the disease,4 patients were treated in local medical institutions and 2 were in our hospital.Among the 6 patients,4 patients were misdiagnosed as having posterior circulation ischemia,1 as pneumonia and one as hypertensive urgency.Misdiagnosed duration was 1 h to 48 h.Treatments for the 6 patients were all ineffective which were treated based on misdiagnosed diseases.Medical history,clinical manifestations and examination results were further analyzed,and then AMI was confirmed finally.All 6 patients were treated with emergency percutaneous coronary intervention(PCI)and placed stents,and then all were discharged after conditions improvement.During the follow-up from 1 month to 3 years,one patient died and other five patients were in good conditions.Conclusion AMI with dizziness as the initial symptom is more likely to be misdiagnosed.Detailed history inquiry,careful physical examinations,expanding diagnostic thinking,timely related examinations and strengthening the study of ECG may reduce or avoid the possibility of misdiagnosis and mistreatment.

关 键 词：心肌梗死 头晕 误诊 后循环缺血 肺炎 高血压 

分 类 号：R542.22[医药卫生—心血管疾病]