应激性心肌病误诊为急性心肌梗死的原因及临床分析OA

Objective To analyze the causes of clinical misdiagnosis of stress-induced cardiomyopathy and strategies for correcting misdiagnosis.Methods A retrospective analysis was conducted on the clinical data of 2 patients who were initially diagnosed with acute myocardial infarction(AMI)but were ultimately confirmed to have stress-induced cardiomyopathy and admitted to Sinopharm Tongmei General Hospital from April 2023 to April 2024.Results One case experienced severe chest pain,retrosternal oppressive pain,shortness of breath,palpitations,accompanied by generalized profuse sweating,nausea,vomiting and syncope once after excessive grief over the death of a close relative.The patient sought medical attention at the Emergency Department of the county hospital within 30 min.Based on the clinical symptoms and two bedside electrocardiogram examinations,the initial diagnosis was AMI,and then the patient was transferred to another hospital.After detailed examination upon admission,it was considered as shock of unknown origin,and symptomatic treatment was given,resulting in improvement of the condition.Further coronary angiography examination showed no obvious stenosis or obstructive lesions in the main branches.Combined with the results of cardiac echocardiography,the final diagnosis was stress-induced cardiomyopathy.The misdiagnosis occurred within 24 h.Symptomatic treatment for stress-induced cardiomyopathy was given for 7 d,and the symptoms improved significantly before discharge.Four weeks after discharge,no abnormalities were found in the electrocardiogram and cardiac function upon re-examination.One case visited the hospital 3 h after experiencing sudden chest pain due to emotional excitement.Based on the clinical manifestations and auxiliary examinations,the initial diagnosis was AMI.Given that the patient was confirmed to be allergic to iodinated contrast agents,conservative treatment was adopted,and the chest pain symptoms were alleviated.Combined with characteristic echocardiography,myocardial enzymes,ST segment manifestations after thrombolysis and the intense emotional trigger,further coronary computed tomography angiography(CTA,using a low-osmolar non-ionic contrast agent)examination showed no significant stenosis or obstructive lesions.The diagnosis was revised to stress-induced cardiomyopathy.The misdiagnosis occurred within 72 h.Symptomatic treatment for stress-induced cardiomyopathy was given,and the symptoms subsided,allowing for discharge.Four weeks after discharge,no abnormalities were found in the echocardiogram and electrocardiogram.Conclusion The clinical manifestations of stress-induced cardiomyopathy are similar to those of AMI,making it prone to misdiagnosis in the early stage.During clinical differential diagnosis,dynamic analysis of electrocardiogram and myocardial enzyme spectrum changes should be conducted,and coronary angiography or CTA should be actively performed to reduce the rate of misdiagnosis.