急性主动脉夹层误诊为急性心肌梗死临床分析

目的对急性主动脉夹层(AAD)误诊为急性心肌梗死的病例进行分析,提高对该病的认识,减少误诊。方法收集北京大学第三医院2001—2010年急诊科收治的AAD误诊为急性心肌梗死的患者,回顾性分析4例患者的临床表现、实验室检查、诊治过程和预后。结果 4例患者均被误诊。4例患者均以胸痛起病,3例心电图表现为ST段弓背向上抬高,1例表现为广泛导联ST段压低,1例心肌酶升高,3例心肌酶正常,4例均给予抗血小板治疗,3例患者行急诊冠状动脉造影检查,4例患者均死亡。结论 AAD患者心电图出现缺血或损伤性改变,极易误诊为急性心肌梗死并给予不适当治疗,病死率高,应重视二者的鉴别诊断。

Clinical Analysis of Acute Aortic Dissection Misdiagnosed as Acute Myocardial Infarction

Objective To analyze patients of acute aortic dissection misdiagnosed as acute myocardial infarction to improve the cognition of acute aortic dissection and reduce misdiagnosis. Methods 4 patients of acute aortic dissection misdiagnosed as acute myocardial infarction in Peking university third hospital from 2001 to 2010 were collected,and their clinical presentation,laboratory testing,diagnosis and treatment were retrospectively analyzed. Results 4 patients were all misdiagnosed.The initial symptom of the 4 cases was chest pain.The electrocardiogram of 3 patients showed ST-segment elevation.The other electrocardiogram showed ST-segment depression.The creatine kinase-MB elevated in one patient,and normal in other 3 patients.4 patients were all given anti-platelet medicine.3 patients were given coronary angiography.4 patients all died. Conclusion When the initial symptom of acute aortic dissection presents chest pain and the electrocardiogram shows ischemic or injury changes,it is likely to be misdiagnosed as acute myocardial infarction and is given improper therapy.The mortality is high and the differential diagnosis should be emphasized.