【摘要】 目的探讨应激性心肌病(stress cardiomyopathy,SCM)的发病机制、诊断及鉴别诊断要点、误诊原因及其防范措施。方法回顾性分析我院收治的1例误诊为急性心肌梗死(AMI)SCM的临床资料。结果患者因情绪激动后持续胸痛、胸闷伴心悸10 h入院。心电图检查示Ⅱ、Ⅲ、a VF及V1~V6导联ST段抬高。查肌酸激酶同工酶及肌钙蛋白I升高。考虑AMI可能。急诊行冠状动脉介入治疗,冠状动脉造影检查未见明显狭窄或闭塞病变;左室造影检查结果显示心尖部呈球形扩大,心尖部弥漫性室壁运动减低。根据造影检查结果确诊SCM。予阿司匹林、美托洛尔、依那普利、瑞舒伐他汀、螺内酯口服及低分子肝素皮下注射等治疗,患者病情好转后自动离院,后失访。结论SCM临床易误诊为AMI。提高对SCM认识、拓宽诊断思路及认真进行鉴别诊断可减少或避免其误诊误治。更多还原

【Abstract】 Objective To study the pathogenesis,diagnosis and differential diagnosis measures,misdiagnosis cause and preventive measures of stress cardiomyopathy( SCM). Methods Clinical data of one case of SCM misdiagnosed as acute myocardial infarction( AMI) was retrospectively analyzed in our hospital. Results The patient was admitted for chest pain,chest tightness and palpitations for ten hours preceded by an emotional stressor. The electrocardiogram( ECG) showed ST segment elevation of Ⅱ,Ⅲ,a VF and V1~ V6. The patient had an increase in creatine kinase MB fraction and cardiac troponin I. AMI was considered at first and the patient underwent immediate treatment for percutaneous coronary intervention( PCI).But coronary angiography was normal. The result of left ventricular angiography was the one of apical ballooning or hypokinesia of the apex of the heart. The diagnosis of SCM was eventually confirmed. The patient’s clinical symptoms improved after the medication of Aspirin,Metoprolol,Enalapril,Rosuvastatin,Antisterone,and Low Molecular Heparin. The patient was discharged after the symptom was improved and the follow-up was lost. Conclusion SCM may mimic AMI. It is necessary to reduce or avoid misdiagnosis and mistherapy and to raise awareness of SCM,widen diagnostic thinking and make differential diagnosis carefully.更多还原