不典型急性心肌梗死的临床症状及心电图分析

Analysis of clinical symptoms and ECG of 41 cases of atypical acute myocardial infarction

目的分析并评价不典型急性心肌梗死(AMI)患者的临床表现及心电图特征,为AMI的临床诊断提供参考。方法对41例不典型AMI患者的临床症状、心电图、心肌酶谱改变以及治疗与转归进行分析。结果 41例患者以消化道及呼吸道症状为主者居多。有9例未见明显的ST段变化,仅见病理Q波;10例仅见ST-T缺血变化或损伤型抬高,未见病理Q波;4例延缓见梗死图形,全部为下壁AMI;3例为常规12导联无梗死图形,属于正后壁AMI;4例原梗死图形消失,V1与V2导联Q波消失,可见小r波;2例死于心力衰竭。结论 AMI的临床诊断应根据临床表现及心肌酶学指标变化,并结合心电图的动态改变进行综合诊断,避免发生误诊。

Objective To analyze and evaluate the infarct atypical acute myocardial （AMI） clinical manifestations and ECG characteristics of the patients, to provide references for the clinical diagnosis of AMI. Methods During 2011 April to 2013 August, a total of 41 cases of atypical AMI patients of clinical symptoms, ECG, myocardial enzyme spectrum changes, treatment and prognosis were analyzed. Results All the 41 patients with digestive tract and respiratory symptoms. 41 cases of atypical AMI in 9 patients with no obvious change of ST segment, while the pathological Q wave; 10 cases ST -T ischemie changes or injury elevation, no pathological Q wave; 4 eases of delayed infarction graphics, all for the inferior wall AMI; 3 cases of routine 12 lead without infarction graphics, which belongs to the posterior wall AMI; 4 cases of infarction graphic disappear, V1 and V2 lead Q wave disappeared, visible R wave; Eventually, the cure rate was 95.12% （39/41）, 2 patients died of heart failure. Conclusion The clinical diagnosis of AMI should be based on clinical manifestations and myocardial enzyme changes, combined with the dynamic ECG changes in comprehensive diagnosis, to avoid misdiagnosis.