 |
 |
误诊原因及与急性心肌梗死的鉴别：3例患者都有心肌缺血的症状、ST段抬高或Q波等ECG改变，并且心肌标记物也是升高的，极易误诊为急性心肌梗死。近几年来随着对本病的认识，统计发现该病约占以急性心肌梗死收住院的2%。但前者多见于有应激史的老年女性，心肌标记物仅轻到中度升高峰值多在24 h内，并且与室壁运动异常的程度及ECG提示的病变范围不符合。冠状动脉造影示梗死相关冠脉血流通畅有助于早期确诊。除此之外ECG亦有差异，前者ST段的抬高是暂时性的，胸前导联的ST段抬高的幅度要低于前壁心梗且较少出现对应导联ST 段压低[11]，且V4～V6 导联ST 段抬高幅度大于V1～V3 导联，但单纯ECG差异尚不能作为确诊条件。总之，应激性心肌病极易误诊为急性心肌梗死，二者治疗截然不同，作为接诊的临床医师应该提高警惕。尤其是有明显应激因素的老年女性，出现胸前导联ST段抬高、心肌缺血症状，不要急于诊断，如果心肌标志物轻到中度升高与ECG提示的病变范围不符时，要及时行床旁超声心动及冠状动脉造影除外此病。
【参考文献】
1 Bybee KA，Kara T，Prasad A，et al.Systematic review： transient left ventricular apical ballooning： a syndrome that mimics ST-segment elevation myocardial infarction.Ann Intern Med,2004,41：858-865.
2 Gianni M，Dentali F，Grandi AM，et al.Apical ballooning syndrome or takotsubo cardiomyopathy： a systematic review.Eur Heart J,2006,27：1523-1529.
3 Elesber A，Prasad A，Lennon R，et al.Four-year recurrence rate and prognosis of the apical ballooning syndrome.J Am Coll Cardiol,2007,10：448-452.
4 Primetshofer D，Agladze R，Kratzer H，et al.Tako-Tsubo syndrome： an important differential diagnosis in patients with acute chest pain.Wien Klin Wochenschr,2010,22：37-44.
5 Nef HM，Mollmann H，Akashi YJ，et al.Mechanisms of stress (Takotsubo) cardiomyopathy.Nat Rev Cardiol,2010,12：187-193.
6 Wittstein IS，Thiemann DR，Lima JA，et al.Neurohumoral features of myocardial stunning due to sudden emotional stress.N Engl J Med,2005,352：539-548.
7 APaham J，Mudd JO，Kapur NK，et al.Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists.J Am Coll Cardiol,2009,53：1320-1325.
8 Prasad A.Apical ballooning syndrome： an important differential diagnosis of acute myocardial infarction.Circulation,2007,115：56-59.
9 Prasad A，Lerman A，Rihal CS.Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy)： a mimic of acute myocardial infarction.Am Heart J,2008,155：408-417.
10 Kimura K，Tanabe-Hayashi Y，Noma S，et al.Images in cardiovascular medicine.Rapid formation of left ventricular giant thrombus with Takotsubo cardiomyopathy.Circulation,2007,115：620-621.
11 Bybee KA，Motiei A，Syed IS，et al.Electrocardiography cannot reliably differentiate transient left ventricular apical ballooning syndrome from anterior ST-segment elevation myocardial infarction.J Electrocardiol,2007,40：381-386
