急性重症心肌炎误诊为急性心肌梗死37例分析

目的总结急性重症心肌炎易误诊为急性心肌梗死的原因。方法对37例酷似急性心肌梗死的急性重症心肌炎的临床表现、诊断方法及误诊原因进行回顾性分析。结果 37例急性重症心肌炎患者中,有低热、咳嗽、咽痛等上感症状8例,胸闷、气促8例,胸痛5例,心慌10例,恶心、呕吐8例,所有病例心肌酶谱均升高,心电图表现酷似下壁心肌梗死8例、前间壁心肌梗死4例、前壁心肌梗死5例、广泛前壁心肌梗死7例、前壁+下壁心肌梗死2例。结论急性重症心肌炎的心电图异常、血清心肌酶升高与急性心肌梗死非常相似,临床易造成误诊,延误治疗。对酷似急性心肌梗死的急性重症心肌炎必须认真询问病史,仔细体格检查,动态分析患者心电图演变,及时行超声心动图、冠状动脉造影和同位素心肌灌注显像等检查认真鉴别,以尽早明确诊断,减少误诊。

Analysis of 37 Cases of Severe Acute Myocarditis that Misdiagnosed as Acute Myocardial Infarction

Objective To summarize the of reason of severe acute myocarditis misdiagnosed as acute myocardial infarction.Methods 37 cases of severe acute myocarditis which look like the acute myocardial infarction,the clinical presentation,diagnosis methods and misdiagnosed reasons were analyzed retrospectively.Results Among the 37 cases of severe acute myocarditis,8 cases with low heat,cough,and sore throat and 8 cases with chest tightness,shortness of breath,5 cases with chest pain,10 cases with flustered,8 cases with nausea,vomiting.All cases had elevated myocardial enzyme.8 cases had under resembles wall myocardial infarction in ecg,4 cases of front wall myocardial infarction,5 cases of front wall myocardial infarction,7 cases of widely front wall myocardial infarction,2 cases of front wall and next wall myocardial infarction.Conclusion Acute myocarditis and acute myocardial infarction were very similar in abnormal ecg,serum myocardial enzymes elevations,so it was frequently misdiagnosed clinically and treatment was delayed.We must carefully ask medical history,carefully do physical examination,dynamicly analyze patients electrocardiogram evolution,timely conduct line echocardiography,coronary arteriography and isotope myocardial perfusion imaging examination identification seriously,to clear diagnosis as early as possible and reduce misdiagnosis.