心肌桥误诊因素分析

目的 :分析有症状心肌桥的临床特点 ,探讨心肌桥误诊原因。方法 :收集 1993- 0 1/2 0 0 0 - 0 5 986例冠状动脉造影中 15例心肌桥病例 ,对比其出入院诊断、ECG与冠状动脉造影结果及临床特点。结果 :心肌桥的初诊误诊率为93.3% ,误诊为冠心病者 1例 ,冠心病稳定型心绞痛者 3例 ,冠心病不稳定型心绞痛者 9例 ,冠心病陈旧下壁心肌梗塞者1例。前降支近中段心肌桥患者 12例 ,前壁缺血占 3/12 ,前侧 下壁缺血占 6 /12 ,侧壁缺血占 1/12 ,下壁缺血占 2 /12。右冠心肌桥患者 3例 ,侧壁缺血占 2 /3,下壁缺血占 1/3。 15例心肌桥患者中有 14例硝酸酯类治疗无效。结论 :心肌桥患者常在中年以后出现酷似冠心病的临床特征及 ECG表现 ,临床确诊的方法是冠状动脉造影。

Analysis of the Reasons for Misdiagnosis of Myocardial Bridge

Objective:To investigate the clinical feature and misdiagnostic reasons for myocardial bridge.Methods:The admitted and discharged diagnosis,clinical feature,and the examination results of electrocardiogram(ECG) and coronary artery angiography were analyzed in 15 cases with myocardial bridge of 986 patients undergoing coronary artery angiography from 1993-01 to 2000-05.Results:The admitted misdiagnosis in the patients with myocardial bridge was 93.3%.Of 15 cases,1 case was misdiagnosed as coronary heart disease,3 as stable angina,9 as unstable angina,and 1 as old inferior myocardial infarction.Among 12 cases with mycardial bridge in the proximal segment or/and midshaft of the left anterior descending artery,there were 3 cases with anterior,6 cases with anterior lateral,and inferior myocardial ischemia,1 case with lateral,and 2 cases with inferior myocardial ischemia,respectively.Among the other 3 cases with myocardial bridge over the major branches of right coronary artery,there were 2 cases with lateral and 1 case with inferior myocardial ischemia.Fourteen of 15 cases with myocardial bridge fail to response to the nitrates therapy.Conclusion:The patients with myocardial bridge after middleage often present the clinical and ECG characteristics which resemble the findings in the patients with coronary heart disease.A key to make a definite clinical diagnosis of myocardial bridge is underlying the coronary artery angiography.