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目的总结急性重症心肌炎易误诊为急性心肌梗死的原因。方法对37例酷似急性心肌梗死的急性重症心肌炎的临床表现、诊断方法及误诊原因进行回顾性分析。结果 37例急性重症心肌炎患者中,有低热、咳嗽、咽痛等上感症状8例,胸闷、气促8例,胸痛5例,心慌10例,恶心、呕吐8例,所有病例心肌酶谱均升高,心电图表现酷似下壁心肌梗死8例、前间壁心肌梗死4例、前壁心肌梗死5例、广泛前壁心肌梗死7例、前壁+下壁心肌梗死2例。结论急性重症心肌炎的心电图异常、血清心肌酶升高与急性心肌梗死非常相似,临床易造成误诊,延误治疗。对酷似急性心肌梗死的急性重症心肌炎必须认真询问病史,仔细体格检查,动态分析患者心电图演变,及时行超声心动图、冠状动脉造影和同位素心肌灌注显像等检查认真鉴别,以尽早明确诊断,减少误诊。
Objective To summarize the causes of acute myocardial infarction misdiagnosed as acute myocardial infarction. Methods Retrospective analysis was performed on the clinical manifestations, diagnosis and misdiagnosis of 37 acute myocardial infarction patients with acute myocardial infarction. Results Among the 37 patients with acute myocarditis, there were 8 symptoms of fever, cough and sore throat, 8 with chest tightness and shortness of breath, 8 with shortness of breath, 5 with chest pain, 10 with palpitation, 8 with nausea and vomiting, Elevated myocardial electrocardiogram resembles inferior wall myocardial infarction in 8 cases, anterior myocardial infarction in 4 cases, anterior myocardial infarction in 5 cases, extensive anterior myocardial infarction in 7 cases, anterior wall + inferior wall myocardial infarction in 2 cases. Conclusion ECG abnormalities in patients with acute severe myocarditis, serum myocardial enzymes and acute myocardial infarction are very similar, easily lead to misdiagnosis, delay treatment. Acute severe myocarditis resembles acute myocardial infarction must seriously ask history, careful physical examination, dynamic analysis of patients with ECG evolution, timely echocardiography, coronary angiography and isotope myocardial perfusion imaging and other tests carefully identified in order to confirm the diagnosis as soon as possible to reduce Misdiagnosis.