老年人查体时发现的心肌梗死──附9例报告

Myocardial infarction found in health check-up for the aged

目的老年人心肌梗死症状常不典型，使心肌梗死诊断准确率较低，因此有必要了解老年人健康查体中发现的心肌梗死的发生率。方法总结１０年中５２０８例次老年人健康查体资料。结果发现急性心肌梗死７例，陈旧性心肌梗死２例，共１０例次，占总查体例次的０．２％。７例急性心肌梗死，占同期住院老年人急性心肌梗死的８．３％。９例平均年龄７４．４±６．６岁，其中６例伴高血压，５例伴糖尿病，４例伴高脂血症。６例无胸痛或其它部位的疼痛。随访３～１０年，６例发生１～３次再次心肌梗死（再梗），死亡５例，其中２例猝死，１例再梗、休克、感染死亡。结论这些查体发现的心肌梗死患者特点为年龄偏大，多无痛，近期预后虽好，但再次心肌梗死率高，远期预后差。

Objective The diagnostic accuracy for myocardial infarction(MI) in the aged is low due to atypical manifestation.As MI may be causually found during health check-up in the aged,it is essential to know the incidence of such an occurrence.Methods The data of 5 208 times of health check-up for the aged in a period of 10 years in Beijing Hospital were reviewed and the incidence,clinical manifestation and outcome studied.Results MI was found 10 times in 9 patients,accounting for 0.2% of the 5 208 times.Seven aged subjects were found to have acute MI and hosprtalized.Old MI was found 3 times with 2 in the same patient at different check-up.The 7 acute cases accounted for 8.3% of the acute MI admitted in the same period.The average age at the time of discovery of MI was 74.44±6.6 years.Six patients had hypertension and 5 had diabetes mellitus as well as hyperlipidemia.Six had no history of precordial pain or pain elsewhere. They were followed for 3-10 years;six of them had reinfarction for one to 3 times and 5 died with 2 of sudden death and one of pump failure as a result of another attack of MI.Conclusion It is shown that the specific clinical features of MI found during health check-up are advanced age of the.patient,absence of pain,good recent prognosis,high reinfarction rate and poor remote outcome.However,such cases of MI might not be discovered if regular health check-up were not carried out.