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您現(xiàn)在的位置: 醫(yī)學(xué)全在線 > 醫(yī)學(xué)論文 > 論文投稿 > 正文:誤診為急性心肌梗死的應(yīng)激性心肌病3例
    

誤診為急性心肌梗死的應(yīng)激性心肌病3例

來源:本站原創(chuàng) 更新:2013-6-6 論文投稿平臺

誤診原因及與急性心肌梗死的鑒別:3例患者都有心肌缺血的癥狀、ST段抬高或Q波等ECG改變,并且心肌標(biāo)記物也是升高的,極易誤診為急性心肌梗死。近幾年來隨著對本病的認(rèn)識,統(tǒng)計發(fā)現(xiàn)該病約占以急性心肌梗死收住院的2%。但前者多見于有應(yīng)激史的老年女性,心肌標(biāo)記物僅輕到中度升高峰值多在24 h內(nèi),并且與室壁運(yùn)動異常的程度及ECG提示的病變范圍不符合。冠狀動脈造影示梗死相關(guān)冠脈血流通暢有助于早期確診。除此之外ECG亦有差異,前者ST段的抬高是暫時性的,胸前導(dǎo)聯(lián)的ST段抬高的幅度要低于前壁心梗且較少出現(xiàn)對應(yīng)導(dǎo)聯(lián)ST 段壓低[11],且V4~V6 導(dǎo)聯(lián)ST 段抬高幅度大于V1~V3 導(dǎo)聯(lián),但單純ECG差異尚不能作為確診條件?傊,應(yīng)激性心肌病極易誤診為急性心肌梗死,二者治療截然不同,作為接診的臨床醫(yī)師應(yīng)該提高警惕。尤其是有明顯應(yīng)激因素的老年女性,出現(xiàn)胸前導(dǎo)聯(lián)ST段抬高、心肌缺血癥狀,不要急于診斷,如果心肌標(biāo)志物輕到中度升高與ECG提示的病變范圍不符時,要及時行床旁超聲心動及冠狀動脈造影除外此病。

【參考文獻(xiàn)】

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11 Bybee KA,Motiei A,Syed IS,et al.Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction.J Electrocardiol,2007,40:381-386

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