老年射血分数保留的心力衰竭误诊为慢性支气管炎原因分析及防范措施  

Causes of Misdiagnosis of Heart Failure with Preserved Ejection Fraction as Chronic Bronchitis in the Elderly and Preventive Measures

作　　者：陈小玉 何君 CHEN Xiaoyu;HE Jun(Department of Cardiology,Wanning People's Hospital,Wanning,Hainan 571500,China)

机构地区：[1]万宁市人民医院心血管内科,海南万宁571500

出　　处：《临床误诊误治》2024年第5期10-13,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的分析老年射血分数保留的心力衰竭(HFpEF)误诊为慢性支气管炎的原因及防范措施。方法回顾性分析2019年10月—2021年4月收治就诊初期误诊为慢性支气管炎的老年HFpEF 7例的临床资料。结果7例以咳嗽、咳痰、乏力、气短为主要症状就诊。3例查血白细胞和中性粒细胞计数稍升高。7例外院行胸部X线检查示双肺纹理增粗、紊乱,2例心影稍大。7例均初诊为慢性支气管炎(急性发作),外院予经验性抗感染、镇咳祛痰等治疗1~2周,症状无明显缓解。入院后经全面分析病情,心电图示心肌缺血及左心室肥厚伴劳损,超声心动图示左心室舒张功能异常,左心室射血分数正常。确诊为HFpEF,误诊时间1~3个月。确诊后予改善左心室舒张功能、降压、缓解肺淤血等治疗后,症状明显减轻或消失。结论老年人基础疾病多,当呼吸系统合并症症状较重掩盖心力衰竭症状时,极易误漏诊;加强对老年HFpEF的认识,详细询问病史,提高对本病的警惕性,仔细鉴别诊断,及时行心电图、超声心动图等检查并综合分析病情,有利于减少或避免误诊误治。Objective To analyze the causes and preventive measures of misdiagnosis of heart failure with preserved ejection fraction(HFpEF)as chronic bronchitis in the elderly.Methods The clinical data of 7 elderly HFpEF patients who were initially misdiagnosed as chronic bronchitis from October 2019 to April 2021 were retrospectively analyzed.Results The main symptoms of 7 patients were cough,phlegm,fatigue and shortness of breath.White blood cell count and neutrophil count were slightly increased in 3 patients.Chest X-ray examination showed thickening and disordered lung texture in 7 patients,and slightly larger heart shadow in 2 patients.All the 7 patients were diagnosed with chronic bronchitis(acute attack)at first,and were treated with empirical anti-infection,antitussive and expectorant treatment in other hospitals for 1-2 weeks,with no obvious remission.After admission,the condition was analyzed comprehensively,and electrocardiogram(ECG)revealed myocardial ischemia,and left ventricular hypertrophy with strain.Echocardiography showed that the left ventricular diastolic function was abnormal,and left ventricular ejection fraction was normal.The diagnosis was HFpEF,and the duration of misdiagnosis was 1-3 months.After diagnosis,the symptoms were obviously alleviated or disappeared after treatment to improve left ventricular diastolic function,reduce blood pressure and relieve pulmonary congestion.Conclusion There are many basic diseases in the elderly,and misdiagnosis is often made when the symptoms of respiratory complications are severe and cover up the symptoms of heart failure.Strengthening the understanding of HFpEF in the elderly,inquiring the medical history in detail,raising the vigilance of the disease,carefully differentiating diagnosis,and timely performing electrocardiogram,echocardiography and comprehensive analysis of the disease are conducive to reducing or avoiding misdiagnosis and mistreatment.

关 键 词：心力衰竭 左心室射血分数 误诊 支气管炎 慢性 心电描记术 心肌缺血 超声心动描记术 压力 诊断 鉴别 

分 类 号：R541.6[医药卫生—心血管疾病]