酷似急性心肌梗死的重症心肌炎7例临床分析

目的了解酷似急性心肌梗死的重症心肌炎患者的心电图改变、临床表现,探讨其诊断方法和治疗措施。方法回顾性分析该院2009年11月至2011年6月期间收治的7例急性酷似心肌梗死的重症心肌炎患者的临床资料,男5例,女2例,年龄17～70岁,平均41岁,住院0.5～25d。结果入院时,7例患者心肌坏死标志物明显增高,心电图呈多导联的ST段抬高,住院期间,6例患者经冠状动脉造影检查,1例患者经双源CT冠状动脉血管成像检查排除急性心肌梗死,经积极纠正心力衰竭、大剂量激素冲击治疗等措施,治愈5例,死亡2例。结论部分重症心肌炎患者的心电图改变和临床表现,酷似急性心肌梗死,行冠状动脉造影,有助于明确诊断。治疗关键在于稳定患者的血流动力学状态,激素冲击治疗可能有助于改善症状,缩短住院天数。

Clinical analysis of myocarditis mimicking acute myocardial infarction in 7 cases

Objective To investigate the diagnosis and treatment of myocarditis mimicking acute myocardial infarction by ECG characteristics and clinical manifestations.Methods Retrospective analysis of the data of 7 patients admitted to our hospital from November 2009 to June 2011,who has been diagnosed as myocarditis mimicking acute myocardial infarction.Among these patients,there were 5 males and 2 females,aged 17 to 70 years,mean 41 years,and 0.5 to 25 days hospitalization.Results On admission,all 7 patients showed significantly higher markers of myocardial necrosis,and their ECG’s ST-segment elevation was high.During hospitalization,these patients were excluded from acute myocardial infarction:6 patients by coronary angiography,and 1 patient by dual-source CT coronary angiography.By applying heart failure treatment,high-dose steroid pulse therapy and other measures,5 cases were cured and the other 2 were dead.Conclusion Coronary angiography is useful for early diagnosis of myocarditis mimicking acute myocardial infarction.The key step is to keep the patients at stable hemodynamic status.High-dose steroid pulse therapy may help alleviate the symptoms and shorten the hospital stay.