误诊为多种心外系统疾病的老年冠心病心力衰竭临床分析  

Clinical Analysis of Elderly Patients with Heart Failure Caused by Coronary Heart Disease Misdiagnosed as Multiple Extracardiac System Diseases

作　　者：赵兴娟 杨帆[1] 于淑华 孙冰岩 赵丽[1] 康翠霞 ZHAO Xingjuan;YANG Fan;YU Shuhua;SUN Bingyan;ZHAO Li;KANG Cuixia(Department of Cardiology,Qinhuangdao Hospital of Peking University Third Hospital,Qinhuangdao,Hebei 066000,China)

机构地区：[1]北京大学第三医院秦皇岛医院心内科,河北秦皇岛066000

出　　处：《临床误诊误治》2024年第7期1-5,共5页Clinical Misdiagnosis & Mistherapy

基　　金：秦皇岛市科学技术研究与发展计划项目(202101A050)。

摘　　要：目的探讨老年人冠心病心力衰竭多系统表现和早期误诊原因。方法分析2021年1月—2023年6月老年冠心病心力衰竭误诊8例临床资料。结果8例中2例咳嗽、咳痰,胸闷气促,两肺底湿啰音,肺纹理增粗紊乱,心电图示ST-T段压低,有慢性支气管炎病史,误诊“慢性支气管炎急性发作”;3例中2例恶心、呕吐,剑突下轻压痛,1例腹痛、腹泻、脐周轻度压痛,心电图示ST-T段压低3例、室性早搏2例,有慢性胃炎病史,误诊“急性胃肠炎”;1例腹胀、食欲不振、乏力,双下肢轻度水肿,丙氨酸转氨酶轻度升高,误诊为“慢性肝炎”;2例头晕、失眠、烦躁不安,心电图示窦性心动过速,有高血压、高脂血症史,误诊“脑动脉硬化症”。经详细询问病史、相关治疗史及认真查体,会诊后完善相关检查,确诊冠心病心力衰竭。误诊时间2~5 d。后予抗心力衰竭治疗,预后良好。随访半年,病情稳定。结论当老年患者以心外系统症状为首诊症状就诊时,应详细询问心脏病史,充分了解伴随症状,认真查体,避免遗漏相关阳性体征,及时行超声心动图、心电图等辅助检查,可有效避免误诊。Objective To investigate the multi-system manifestations and early causes of misdiagnosis of heart failure caused by coronary heart disease(CHD)in the elderly.Methods The clinical data of 8 patients with heart failure caused by CHD misdiagnosed from January 2021 to June 2023 were analyzed.Results Among the 8 patients,2 patients had cough,phlegm,chest tightness and shortness of breath,wet rales at the bottom of both lungs,thickened and disordered lung texture,ST-T segment depression on electrocardiogram(ECG),history of chronic bronchitis,and were misdiagnosed as acute attack of chronic bronchitis.Of 3 patients,there was nausea,vomiting,and mild tenderness under xiphoid process in 2 patients,abdominal pain,diarrhea,mild tenderness around umbilicus in 1 patient,ST-T segment depression in 3 patients,and premature ventricular contractions in 2 patients,who had a history of chronic gastritis and were misdiagnosed with acute gastroenteritis.One patient was misdiagnosed as chronic hepatitis due to abdominal distension,loss of appetite,weakness,mild edema of both lower limbs and slight elevation of alanine aminotransferase.Two patients had dizziness,insomnia,irritability,sinus tachycardia on ECG,history of hypertension,history of hyperlipidemia,who were misdiagnosed with cerebral arteriosclerosis.After detailed inquiry about medical history and relevant treatment history and careful physical examination,relevant examinations were performed following consultation,heart failure due to coronary heart disease was confirmed.Misdiagnosis lasted 2 to 5 d.The prognosis was good after anti-heart failure treatment.The patients were followed up for six months and their condition was stable.Conclusion When elderly patients presented with symptoms of extracardiac system as the initial symptom,clinicians should inquire about the history of heart disease in detail,fully understand the accompanying symptoms,carefully perform physical examination,avoid missing relevant positive signs,and perform auxiliary examinations such as echocardiogr

关 键 词：冠心病 心力衰竭 老年人 误诊 慢性支气管炎急性发作 急性胃肠炎 慢性肝炎 脑动脉硬化症 

分 类 号：R541.4[医药卫生—心血管疾病] R541.6[医药卫生—内科学]