以不典型症状为首发表现的主动脉夹层误诊为冠心病分析

Aortic Dissection with Atypical Symptoms as the Initial Manifestation Misdiagnosed as Coronary Heart Disease

目的分析不典型症状的主动脉夹层(AD)的误诊原因,以加强首诊医生对AD的认识,减少临床误诊误治。方法回顾性分析2例以不典型症状为首发表现的AD误诊为冠心病的诊治过程。结果1例仅表现为阵发性胸痛伴有腹痛、腹泻,因胃肠炎病史而病初诊断为不稳定型心绞痛合并急性胃肠炎。1例仅表现为胸闷,病初诊断为可疑冠心病。2例均有冠心病危险因素拟行冠状动脉造影检查,于术前行相关影像学检查中发现AD,因经济原因未行手术治疗并出院。结论临床医生应提高对不典型症状AD的诊断意识及鉴别能力,注重临床查体的重要性,同时完善相关检查可减少不典型症状AD的误诊及漏诊。

Objective To analyze misdiagnosed causes of aortic dissection(AD)with atypical symptoms so as to enhance the understanding of AD by first attending doctors and reduce clinical misdiagnosis and mistreatment.Methods Clinical data of 2 AD cases misdiagnosed as having coronary heart disease(CHD)with atypical symptoms as the initial manifestation was retrospectively analyzed.Results 1 case was diagnosed as having unstable angina pectoris complicated with acute gastroenteritis due to paroxylated chest pain accompanied by abdominal pain and diarrhea.1 case presented with only chest tightness and was initially diagnosed as having suspicious CHD.Coronary angiography was planned for both patients with CHD risk factors.AD was found in preoperative imaging examination,but surgery was not performed for economic reasons,and they were discharged from hospital.Conclusion Clinicians should improve the awareness and differential ability of the diagnosis of AD with atypical symptoms,pay attention to the importance of clinical physical examination and improve the relevant examination,which can reduce the misdiagnosis and missed diagnosis of AD with atypical symptoms.