临床误诊误治2024，Vol.37Issue(4)：6-10,5.DOI:10.3969/j.issn.1002-3429.2024.04.002
以心外症状首发的老年急性心肌梗死临床误诊分析
Clinical Misdiagnosis of Acute Myocardial Infarction in the Elderly with Extracardiac Symptoms
摘要
Abstract
Objective To investigate the atypical manifestations of acute myocardial infarction(AMI)in the elderly,and to analyze the causes of misdiagnosis and preventive measures of AMI patients with extracardiac symptoms.Methods The clinical data of 12 patients with misdiagnosed AMI admitted from February 2020 to February 2023 were retrospectively an-alyzed.Results Twelve patients were aged 61-75 years.Due to the history of bronchitis,4 patients had cough,chest tight-ness,palpitation,dyspnea,fever,increased lung texture,and thickening,and were initially diagnosed with pneumonia.Of 8 patients,3 cases had onset of disease after high-fat meal and 3 cases after alcohol consumption.There were 4 patients with a-cute upper abdominal pain,nausea and vomiting,accompanied by fever,and 3 cases with dizziness,fatigue and subxiphoid tenderness.Abdominal B-ultrasonography showed thickening and rough gallbladder wall in 2 patients,and the preliminary di-agnosis was acute enteritis in 6 patients and acute cholecystitis in 2 patients.The duration of misdiagnosis was 6-27 h.There was no obvious remission in 12 patients after corresponding treatment.AMI was diagnosed by physical examination,laboratory examination,electrocardiogram(ECG)and coronary angiography.Coronary intervention was performed in all patients.They were hospitalized for 10-14 d and discharged with improved condition.They were followed up for 2-6 months and the prognosis was favorable.Conclusion AMI in elderly patients is complicated and varied,with atypical manifestations in the early stage,which showed extracardiac symptoms initially.It is more likely to be misdiagnosed if the ECG is normal or the myocardial en-zyme test is not performed in the early stage.Detailed interview,careful physical examination,timely ECG and myocardial en-zyme examination,careful differential diagnosis and comprehensive analysis of the disease can help reduce or avoid misdiagno-sis and mistreatment of atypical AMI in the elderly.关键词
心肌梗死/老年人/心外症状/误诊/肺炎/肠炎/胆囊炎/诊断Key words
Myocardial infarction/Elderly/Extracardiac symptoms/Misdiagnosis/Pneumonia/Enteritis/Cholecys-titis/Diagnosis分类
临床医学引用本文复制引用
钱小菁,张鹏飞,高峰..以心外症状首发的老年急性心肌梗死临床误诊分析[J].临床误诊误治,2024,37(4):6-10,5.基金项目
2022年度安徽省科研编制计划项目(2022AH050771) （2022AH050771）
