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目的探讨临床症状及早期心电图均不典型的急性心肌梗死(AMI)误诊原因。方法动态观察不典型心梗的临床表现、心电图及心肌酶谱变化。结果老年糖尿病、动脉硬化患者临床表现不典型,如低血压休克、左心衰竭、上腹痛、恶心、牙痛。早期心电图不典型,主要表现为心律失常如左束支传导阻滞、频发室性早搏、室性心动过速、Ⅲ度房室传导阻滞;非特异性 ST-T 改变;心电图正常。结论对于典型的临床表现,特征性心电图改变的患者,AMI 诊断明确。但对于临床症状及心电图表现均不典型者,临床误诊率较高。
Objective To investigate the causes of misdiagnosis of acute myocardial infarction (AMI) in which clinical symptoms and early electrocardiogram are not typical. Methods Dynamic observation of atypical myocardial infarction clinical manifestations, ECG and myocardial zymogram changes. Results Elderly patients with diabetes and atherosclerosis clinical manifestations of atypical, such as hypotensive shock, left heart failure, upper abdominal pain, nausea, toothache. Early ECG is not typical, mainly as arrhythmias such as left bundle branch block, frequent premature ventricular contractions, ventricular tachycardia, Ⅲ degree atrioventricular block; non-specific ST-T changes; normal ECG. Conclusions For patients with typical clinical manifestations and characteristic ECG changes, the diagnosis of AMI is clear. However, clinical symptoms and ECG performance are not typical, a higher rate of clinical misdiagnosis.