主动脉夹层误诊为急性心肌梗死临床分析OA

Objective To analyze the reasons for misdiagnosis of aortic dissection as acute myocardial infarction(AMI),and to summarize the methods for correcting such misdiagnosis,so as to improve the diagnostic skills of clinical physicians.Methods A retrospective analysis was conducted on the clinical data of 2 patients with aortic dissection who were misdiagnosed as having AMI from June 2020 to June 2023.Results One patient presented with chest pain and vomiting for 3 h.Based on the clinical symptoms,the physical examination upon admission,and the electrocardiogram(ECG)results indicating sinus rhythm with T-wave changes in the chest leads(flattened in V3-V4 and shallow inversion in V5-V6),the initial diagnosis was AMI and grade 3 hypertension(extremely high risk),and symptomatic treatment was given.On the second day of treatment,the patient's chest pain suddenly worsened to an unbearable level.Subsequently,ECG examination,laboratory tests,and a CT angiography of the aorta were performed,and the final diagnosis was descending aortic dissection of DeBakey type Ⅲ,accompanied by bilateral pleural effusion.The misdiagnosis lasted 24 h.After one week of internal medical treatment,the patient's condition improved and was transferred to another hospital for aortic stent-graft implantation.The operation was successful,and the patient recovered well.Another patient presented with a tearing-like severe pain behind the sternum for 1 h.Based on the clinical symptoms,physical examination,and bedside ECG results,the diagnosis was acute inferior wall ST-segment elevation myocardial infarction.Symptomatic treatment was immediately administered.During the treatment period,further laboratory tests were conducted,and an expert consultation was organized.The family declined to undergo coronary angiography and signed an informed consent form.Intravenous thrombolysis was given for 2 h,but the patient's chest pain did not significantly relieve.Bedside full-channel ECG,bedside echocardiography,aortic ultrasound,and enhanced CT of the aorta were performed again to correct the diagnosis as aortic dissection(Stanford type A).The misdiagnosis lasted 2 h.The patient and the family declined to undergo surgical treatment at another hospital and received conservative treatment for 14 d.The patient's condition improved and was discharged.At seven months after discharge,the patient died due to ineffective rescue from heart failure.Conclusion Patients with aortic dissection are prone to misdiagnosis of AMI and receive inappropriate treatment accordingly.Clinicians should be vigilant,pay attention to the key points for differentiating the two conditions,conduct detailed inquiries and thorough physical examinations,and promptly carry out targeted imaging examinations to reduce or avoid misdiagnosis and mistreatment of aortic dissection.