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目的:探讨电张调整性T波改变患者被误诊为急性心肌梗塞的原因。方法:对7例显性预激综合征患者成功射频消融术后出现电张调整性T波改变,而被误诊为急性心肌梗塞的患者进行镇静、止痛治疗,而不进行溶栓治疗。并观察其临床表现、心电图、肌钙蛋白T、肌酸磷酸激酶的同工酶(CK-MB)。结果:7例患者均为显性预激综合征,其中右后间隔旁道3例、左侧游离壁旁道4例,所有患者术后心电图T波的方向与术前心脏激动顺序改变时QRS波群方向一致。3例右后间隔旁道患者下壁导联T波倒置深度Ⅲ>aVF>Ⅱ,出现ST压低;4例左侧游离壁旁道患者高侧壁导联T波倒置深度aVL>Ⅰ,V1～V6导联出现不同程度J点抬高、J波和ST段水平抬高;镇定和止痛等对症治疗2～3 d,心前区疼痛消失,肌钙蛋白T阴性(射频消融术后4～6 d),CK-MB均正常,随访8～10 w后心电图恢复正常。结论:急诊专业的医师对电张调整性T波改变缺乏认识;医生没有仔细询问病史,对射频消融术治疗预激综合征认识不足;对急性心肌梗塞的诊断认识不全面。以上是导致错误诊断的重要的原因。
OBJECTIVE: To investigate the causes of misdiagnosed acute myocardial infarction (TAM) in patients with altered T wave. Methods: Seven patients with dominant WPW syndrome underwent radiofrequency ablation after successful radiofrequency ablation T wave changes, while those who were misdiagnosed as acute myocardial infarction were treated with sedation and analgesia without thrombolytic therapy. The clinical manifestations, electrocardiogram, troponin T and creatine phosphokinase isoenzyme (CK-MB) were observed. Results: All the 7 patients were dominant WPW syndrome. Among them, 3 cases had right posterior septal bypass and 4 cases had left paranasal bypass. The direction of postoperative ECG T wave and QRS Wave group direction. Three patients with right posterior segmentectomy led to lower T wave inversion depth Ⅲ> aVF> Ⅱ, and ST depression occurred. In four patients with left circumflex artery, the T wave inversion depth aVL> Ⅰ, V1 ~ V6 lead to varying degrees of J point elevation, J wave and ST segment elevation; sedation and analgesia symptomatic treatment of 2 to 3 days, the anorexia disappeared, troponin T-negative (after radiofrequency ablation 4 to 6 d), CK-MB were normal, follow-up 8 ~ 10 w electrocardiogram returned to normal. CONCLUSION: The emergency physician lacked a clear understanding of T wave changes. The doctor did not ask history carefully and did not know enough about radiofrequency ablation to treat WPW syndrome. The diagnosis of acute myocardial infarction was not comprehensive. These are the important reasons that led to the wrong diagnosis.