胆绞痛误诊为心绞痛八例临床分析

文献曾报道误诊的非心源性心绞痛40例中,有11例为胆系疾病(27%)[1],说明临床医生对心绞痛的警惕性较高,易将不典型胆绞痛误诊为心绞痛。我院2001年1月~2006年7月收治胆结石并冠心病和(或)有冠心病高危因素者327例,其中早期不典型胆绞痛误诊为心绞痛8例(7.5%),现总结报告如下。1临床资料1.1一般资料本组男5例,女3例;年龄46~81岁。既往均有冠心病史,其中伴高血压病5例,心律失常、高脂血症各4例,糖尿病2例,甲状腺功能亢进症、脑梗死各1例。否认胆结石病史5例,病史不详3例,均系餐后发病就诊。1.2临床表现本组均有胸部及剑突不适,胸痛3例;胸闷、…     

非心源性心绞痛误诊为冠心病心绞痛28例分析

目的：报告非心源性心绞痛被误诊为冠心病心绞痛的临床分析。方法：28例患者行心电图,心电图运动负荷试验,18例行超声心动图,5例行冠状动脉造影。部分行B超、X线片、胃镜等检查。结果：确诊为返流性食管炎8例,胆石症6例,急性胆囊炎3例,颈椎病2例,胃溃疡2例,心脏神经官能症2例,更年期综合征3例,肋间神经痛2例。结论：非心源性心绞痛易被误诊为冠心病心绞痛。     

非缺血性胸痛误诊为心绞痛47例分析

临床上有些患者的非缺血性胸痛酷似冠心病心绞痛 ,现将1992～ 2 0 0 0年笔者所遇到的非缺血性胸痛误诊为心绞痛 4 7例报告分析如下。1　临床资料1.1　一般资料　本组男 2 0例 ,女 2 7例。年龄 36～ 79岁 ,平均5 8.6岁 ,6 0岁以上 2 5例。既往高血压病 2 9例 ,高脂血症 17例 , 型糖尿病 7例 ,颈椎病 6例。吸烟 17例 ,肥胖 (BMI>2 8) 19例 ,病程 2周～ 3a。1.2　临床表现　以发作性胸痛为主诉 2 8例 ,胸骨后持续刺痛或灼痛 10例 ,阵发胸闷 5例 ,上腹疼痛不适 4例 ,伴下颌闷痛或左肩臂放射痛 13例。疼痛持续时间几分至 0 .5 h不等。症状发作…     

心源性牙痛误诊分析

心源性疼痛最常放射的部位为:左臂、左肩、颈部和面部,以牙痛为首发症状的冠心病(心绞痛型冠心病和心肌梗塞型冠心病)临床少见[1,2].我院1996-12～2004-06收治心源性牙痛13例,就其临床诊断和治疗及其误诊原因分析如下. 1 对象和方法 本组男9例,女4例,年龄40～75岁.心绞痛型冠心病8例,其中劳累型心绞痛4例,自发性心绞痛2例,混合型心绞痛2例;心肌梗塞型冠心病5例.本组到心内科治疗前1个月左右有阵发性牙痛先兆,其中8例不明原因突然发生后牙疼痛,呈持续性,劳累后疼痛加重,休息后疼痛减轻.到口腔科就诊诊断为牙髓炎和楔状缺损,经洁齿和充填术治疗,牙痛未见好转.查ECG示胸前V1～V5导联ST段呈水平型压低0.1～0.3 mv以及T波倒置,被确诊为:①心源性牙痛;②心绞痛型冠心病,转心内科治疗.其中5例因活动后,突然出现双侧后下牙疼痛,休息2～5 min后,疼痛缓解.既往无高血压病史.口腔科检查:未见龋坏的牙齿及根尖周炎.ECG显示:胸前导联V1～V4呈QS型,ST段呈弓背向上抬高.被确诊为:①心源性牙痛;②心肌梗塞型冠心病.     

食管源性胸痛误诊为冠心病心绞痛20例分析

食管疾病所致胸痛。有时颇似冠心病心绞痛发作,导致误诊误治。本文将我们近年来遇到的20例报告如下。资料与方法一、一般资料本组男12例、女8例,年龄45～68岁。临床特点:20例均表现为胸骨后疼痛,有的伴有烧灼感,13例有明显的心前区不适。胸痛多为间断性钝痛,有时呈心绞痛发作样疼痛。3例胸痛发作与饮食有关,为吞咽终末疼痛。10例于体力活动时诱发。11例时有暖气与返酸。20例均误诊为冠心病心绞痛,误诊时间1个月至3年不等。     

慢性胆囊炎胆石症误诊78例分析

慢性胆囊炎、胆石症是临床常见病、多发病之一 ,但因其无特异性症状而易误诊。我院 1991- 0 8～ 1996 - 0 8共收治慢性胆囊炎、胆石症 2 2 4例 ,其中误诊 78例 ,误诊率为 34.8% ,分析如下。1　临床资料本组男 2 8例 ,女 5 0例 ,年龄 17～ 72 (平均 4 1.6 )岁 ,误诊时间 1～ 32 a,其中 1～ 5 a5 2例。误诊为慢性胃炎者 4 8例 ,胃十二指肠溃疡 18例 ,病毒性肝炎 8例 ,心绞痛 2例 ,心律失常、冠心病各 1例。本组均缺乏胆绞痛 ,反射痛及莫菲氏征阳性等典型症状或体征。而常以各种上消化道病症就诊。误为慢性胃炎的4 8例 ,主要表现为上腹不适 ,饱…     

原发心脏疾病并发心源性脑梗死69例临床分析

目的探讨原发心脏疾病并心源性脑梗死的临床特点。方法分析行心内直视手术的69例原发心脏疾病并心源性脑梗死患者临床资料,记录原发心脏疾病种类、末次心源性脑梗死发生至实施心脏手术的时间以及治疗、随访结果。结果本组心脏瓣膜病37例,感染性心内膜炎19例,心脏黏液瘤7例,黏液瘤综合征1例,冠心病合并左心室室壁瘤5例;手术治愈66例,死亡3例,其中末次心源性脑梗死发生2个月内手术者22例,死亡2例,2个月后手术者47例,死亡1例;术后随访（38.7±13.1）个月,无新增死亡病例和再次脑梗死发生。结论心源性脑梗死其原发心脏疾病种类多样,心脏手术时机需视心脏病变情况及脑梗死严重程度而决定;及时诊断和治疗原发心脏疾病是预防再次或多次脑梗死的关键。     

老年非心源性心绞痛误诊34例分析

心绞痛是由于冠状动脉供血不足 ,心肌缺血、缺氧所引起的以阵发性胸前疼痛为主要表现的疾病。由于老年人的生理及病理特性 ,尚有许多非心脏因素出现类似于心绞痛的症状 ,在临床上极易误诊。我科自 1995 - 0 7～ 2 0 0 0 - 10 ,共遇误诊病例34例 ,现就其误诊情况作一分析。1　临床资料本组男 2 8例 ,女 6例 ,年龄 6 4岁～ 80岁 ,平均 71岁。被误诊前病程最长 6 a,最短 3d。患者来源 :从个体诊所转来者 18例 ,厂矿医院转来者 9例 ,本院门诊 4例 ,他科会诊 3例。主要合并症 :合并糖尿病 7例 ,合并高血压 13例 ,合慢支、肺气肿 12例。所有患者均…     

胃食管反流病误诊为心绞痛13例分析

我科2003-03～2006-12将胃食管反流病(GERD)误诊为心绞痛13例,误诊原因分析如下。1临床资料1.1一般资料本组男8例,女5例,年龄40～68岁。烧心或反酸13例,吞咽困难5例,胸骨后疼痛13例,咽部不适8例,其     

带状疱疹误诊为不稳定性心绞痛8例分析

现将我院2003／2006年8例带状疱疹误诊为不稳定性心绞痛分析如下。 1 临床资料 1．1 一般资料 本组女5例，男3例，年龄60～74（平均65）岁。有冠心病史2例，高血压史2例，糖尿病史2例，2例健康。入院前病程1～5d。疼痛呈发作性，剧烈，为针刺样、烧灼样或刀割样，每次持续数分钟至0．5h，     

Headache angina

The initial recognition of acute myocardial infarction at the time of the emergency department (ED) visit may be difficult in the absence of typical presentations such as chest pain, diaphoresis, and radiation tenderness. Headache angina, although reported in several instances in the past with variable patient outcomes, is still an uncommon phenomenon in patients with acute myocardial infarction. We report a patient with inferior myocardial infarction who presented to the ED with a complaint of severe headache and subsequent cardiogenic shock secondary to ventricular fibrillation.     

Ludwig's angina

The case is described of an occurrence of Ludwig's angina with advanced stage of the disease with progressive and rapid airway compromise and fatal consequence. A review of the literature is undertaken to gain a better understanding of the disease, and gives the opportunity for presenting a summary of the key issues regarding this dreaded disease, particularly the immediate management of it in the emergency department.     

Unstable angina

Unstable angina can manifest as an array of symptom complexes. In some patients, medical therapy will stabilize the episodes of angina, and only predismissal exercise testing or angiography (or both) will be necessary. At the other end of the spectrum are patients with rest angina or multiple episodes of silent ischemia who are refractory to medical therapy and experience undetected microinfarction. Most of these patients require immediate catheterization and subsequent intervention with intra-aortic balloon pulsation, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. An entire spectrum of manifestations exists between these two extremes. One challenge during the 1990s will be better stratification of patients with unstable angina so that safe, efficient, cost-effective treatment strategies can be appropriately applied to all patients.     

Intestinal angina

The outlook for chronic ischemic disease of the intestine must stress several factors: (1) the clinical entity is uncommon, (2) vascular occlusion is common, (3) diagnosis is most difficult, and (4) angiography is indispensable for diagnosis, but the procedure is not without hazard. Proper evaluation of all factors, with proper selection of patients who would benefit from revascularization procedures, is essential. The future evaluation and alleviation of ischemic bowel disease may well depend on skills of the past, i.e., a thorough, painstaking history of the existing illness.     

Unstable angina

Properly treated unstable angina and non-Q wave myocardial infarction have low hospital mortality, but untreated, mortality is high. Symptoms and labs usually suffice for diagnosis. Abnormal physical findings are rarely helpful and oftern absent. Careful surveillance and management substantially reduce long-term risks. The authors have stated that they do not have a significant financial interest or other relationship with any product manufacturer or provider of services discussed in this article. The authors also do not discuss the use of off-label products, which includes unlabeled, unapproved, or investigative products or devices.