急性心肌梗死误诊原因分析及防范对策  

Cause Analysis and Preventive Measures of Misdiagnosis of Acute Myocardial Infarction

作　　者：韦霄攀 高俊峰 王乐丰[2] 刘宇[2] 王慧敏 WEI Xiaopan;GAO Junfeng;WANG Lefeng;LIU Yu;WANG Huimin(Department of Cardiology,Beijing Huairou Hospital,Beijing 101400,China;Department of Cardiology,Beijing Chaoyang Hospital,Beijing 100020,China)

机构地区：[1]北京怀柔医院心内科,北京101400 [2]北京朝阳医院心内科,北京100020

出　　处：《临床误诊误治》2025年第8期23-28,共6页Clinical Misdiagnosis & Mistherapy

基　　金：北京市医院管理局2018年度消化内科学科协同发展中心重点项目(XXZ0607)。

摘　　要：目的分析急性心肌梗死(AMI)误诊的原因,并探讨减少误诊的有效对策,以期提高临床诊断的准确性。方法回顾分析2022年12月至2023年12月收治的3例AMI误诊病例资料。结果1例因突发胸骨后压榨性疼痛伴大汗就诊,无冠心病史,行十二导联心电图检查无明显异常,初诊为胃食管反流病,经抗酸治疗无效,次日症状加重,经复查心电图、心肌坏死标志物及冠状动脉造影检查后确诊为急性前壁心肌梗死;1例主诉上腹剧烈疼痛伴恶心、呕吐,无冠心病史,初诊为急性胰腺炎,常规治疗后症状未缓解,进一步行心电图、心肌坏死标志物及冠状动脉造影检查,最终确诊为急性下壁心肌梗死;1例因突发呼吸困难及剧烈胸痛伴背部放射痛就诊,初诊为急性肺栓塞,行胸部CT血管造影排除肺栓塞后,通过心电图、心肌坏死标志物及冠状动脉造影检查确诊为急性下壁心肌梗死。3例误诊时间分别为30、10、6 h。3例确诊后均行经皮冠状动脉介入治疗,预后良好。结论AMI的误诊主要是由于其临床表现多样性和不典型性;提高医务人员的诊断警惕性、规范诊疗流程、多次行心电图和心肌坏死标志物检测及多学科协作是减少本病误诊的重要措施。Objective To analyze the causes of misdiagnosis of acute myocardial infarction(AMI)and to explore the effective countermeasures to reduce misdiagnosis,so as to improve the accuracy of clinical diagnosis.Methods The data of 3 patients with AMI misdiagnosed and then treated from December 2022 to December 2023 were retrospectively analyzed.Results One patient presented with sudden retrosternal compression pain accompanied by sweating,and had no history of coronary heart disease(CHD).A 12-lead electrocardiogram(ECG)examination showed no obvious abnormality,and the patient was initially diagnosed as gastroesophageal reflux disease(GERD).After ineffective anti-acid therapy,the symptoms worsened the next day.After re-examination of ECG,myocardial necrosis markers,and coronary angiography,it was diagnosed as acute anterior wall myocardial infarction.One patient complained of severe upper abdominal pain accompanied by nausea and vomiting and had no history of CHD.Acute inferior myocardial infarction was confirmed by further ECG,markers of myocardial necrosis and coronary angiography after routine treatment.One patient was diagnosed with acute pulmonary embolism due to sudden dyspnea and severe chest pain with radiating back pain.After pulmonary embolism was ruled out by chest CT angiography,acute inferior myocardial infarction was confirmed by ECG,markers of myocardial necrosis,and coronary angiography.The misdiagnosis of 3 patients lasted 30,10,and 6 h,respectively.All 3 patients received percutaneous coronary intervention after diagnosis,and the prognosis was good.Conclusion The misdiagnosis of AMI is mainly due to the diversity and atypia of its clinical manifestations.The important measures to reduce the misdiagnosis of this disease included improvement of the vigilance of medical staff,standardization of the diagnosis and treatment process,multiple examinations of ECG and myocardial necrosis markers and cooperation with various disciplines.

关 键 词：心肌梗死 急性 误诊 胃食管反流病 急性胰腺炎 急性肺栓塞 鉴别诊断 心电图 冠状动脉造影 

分 类 号：R542.22[医药卫生—心血管疾病]