临床误诊误治2025，Vol.38Issue(15)：7-11,5.DOI:10.3969/j.issn.1002-3429.2025.15.002
急性主动脉夹层误诊为急性心肌梗死临床分析
Clinical Analysis of Misdiagnosis of Acute Aortic Dissection as Acute Myocardial Infarction
摘要
Abstract
Objective To analyze the causes of acute aortic dissection(AAD)misdiagnosed as acute myocardial infarction(AMI)and to explore the preventive measures.Methods The clinical data of 1 AAD patient misdiagnosed as AMI in February 2023 were retrospectively analyzed.Results This patient presented with sudden chest distress and burning sensation under xiphoid process.Electrocardiogram showed sinus rhythm,QS pattern in leads V1-V2,and T wave changes(positive and negative or inverted T wave in anterior and inferior leads).Echocardiography showed a decrease in left ventricular diastolic function and segmental ventricular wall motion abnormality.Coronary angiography(CAG)showed segmental non-calcified plaque in the wall of the middle segment of the left anterior descending artery with mild lumen stenosis,and a localized mixed plaque in the first obtuse marginal branch with moderate luminal stenosis,which was misdiagnosed as AMI.The symptoms were not relieved after corresponding treatment.AAD was confirmed by aortic CT angiography(CTA).The duration of misdiagnosis was 1 d.Antithrombotic drugs were stopped immediately,and Sodium Nitroprusside for blood pressure control,Esmolol for ventricular rate control,and Dezocine for analgesia were provided.The patient underwent surgical treatment in a higher-level hospital.After 1 year of follow-up,the patient's condition was stable.Conclusion The symptoms of AAD are very complex and varied,and it is more likely to be misdiagnosed.The physician should pay enough attention to the disease,conduct a comprehensive and detailed inquiry and physical examination,and perform aortic CTA in time to prevent misdiagnosis.AAD has a high mortality rate,therefore,early diagnosis and prompt treatment are of great significance for effectively reducing the risk of death in patients with AAD.关键词
动脉瘤,夹层/主动脉疾病/误诊/心肌梗死/主动脉造影术/心电描记术/预后Key words
aneurysm,dissection/aortic diseases/misdiagnosis/myocardial infarction/aortography/electrocardiography/prognosis引用本文复制引用
陈为英,李雪纯,柯俊杰,张传峰,朱德才,陈优优..急性主动脉夹层误诊为急性心肌梗死临床分析[J].临床误诊误治,2025,38(15):7-11,5.基金项目
安徽省教育厅高校科学研究项目(KJ2021A0345) （KJ2021A0345）
亳州市卫生健康科研项目(bzwj2024b019) （bzwj2024b019）
