摘要
目的探讨心电图表现酷似急性冠状动脉综合征的急性病毒性心肌炎的临床表现、诊断和治疗。方法回顾2008年6月至2014年6月期间上海市第一人民医院收治的20例心电图表现酷似急性冠状动脉综合征的急性病毒性心肌炎患者的临床资料,其中男12例,女8例,年龄17~60岁,平均年龄38岁,住院6~14天。结果入院时所有患者心肌损伤标志物均明显增高,心电图下壁或前壁ST段呈弓背向下抬高。住院期间20例患者均经冠状动脉造影或冠状动脉CT血管造影检查排除急性心肌梗死,经心脏核磁共振、心内膜心肌活检等检查诊断为急性病毒性心肌炎,其中4例诊断为急性重症病毒性心肌炎。经抗心力衰竭、营养心肌、降低心肌氧耗、血管紧张素转换酶抑制剂等综合治疗,19例治愈,1例诊断为急性重症病毒性心肌炎患者死亡。结论部分急性病毒性心肌炎患者心电图及临床表现酷似急性冠状动脉综合征,易误诊,需结合患者病史、临床表现、心电图、冠状动脉造影、心脏增强核磁共振等检查作出及时诊断。
Aim To investigate the clinical manifestation,diagnosis and treatment of acute viral myocarditis as acute coronary syndromes by electrocardiogram( ECG) characteristics. Methods Retrospective analysis was carried out for the data of 20 patients adimitted to Shanghai First People's Hospital from June 2008 to June 2014. These patients had been diagnosed as acute viral myocarditis,but looking as acute coronary syndromes. Among these patients,there were 12 males and 8 females,aged 17 ~ 60 years,mean 38 years,and 6 ~ 14 days hospitalization. Results On admission,all 20 patients showed significant higher markers of myocardial necrosis,and their ECG 's ST-segments were arched elevation in the inferior wall or front wall. During hospitalization,these patients were excluded from acute myocardial infarction by coronary angiograph or coronary computed tomography angiography( CTA). Meanwhile,they were diagnosed as acute viral myocarditis by cardiac magnetic resonance,endomyocardial biopsy,and 4 cases were diagnosed as acute severe viral myocarditis. By applying heart failure treatment,myocardial nutrition,reducing myocardial oxygen consumption,angiotensin converting enzyme inhibitor and other comprehensive treatment,19 cases were cured,and 1 case of acute fulminant myocarditis was dead. Conclusion Part of acute viral myocarditis patients resemble the ECG characteristics and manifestations of acute coronary syndrome,and is easy to be misdiagnosed. It is necessary to combine patient history,clinical manifestations,ECG,coronary angiography,cardiac enhanced magnetic resonance examination to make timely diagnosis.
出处
《中国动脉硬化杂志》
CAS
北大核心
2015年第3期307-309,共3页
Chinese Journal of Arteriosclerosis
