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Oligohydramnios clinical analysis of 96 cases


Students severe arrhythmia, shock, emerging or aggravation of existing heart failure due to unknown causes, or sudden severe and persistent chest tightness, wheezing, syncope, extreme weakness, weakness, acute indigestion, sore throat, teeth pain, shoulder pain and other symptoms of conventional hard to explain, taking into account acute myocardial infarction. Treatment when patients have to physicians detailed history, detailed physical examination, the diagnosis of unknown patients, should be routine to the ECG, for suspicious cases should be dynamic observation of ECG, creatine kinase (CK-MB), muscle Ca protein (cTnT), to reduce the acute myocardial infarction misdiagnosed. Key words acute myocardial infarction; misdiagnosed; prevention of acute myocardial infarction (AMI) patients with atypical clinical manifestations often misdiagnosed and delayed treatment, causing serious consequences. Our hospital from January 2005 to January 2008 38 cases of misdiagnosed cases,[link widoczny dla zalogowanych], are as follows. 1 1.1 General Information The clinical data of 38 cases of patients, 21 males and 8 females; aged 48-75 years, mean age 61.5 years; onset to admission time was 1h ~ 4d, a previous history of heart disease cases. 1.2 The clinical manifestations of gastrointestinal symptoms as the main manifestation in 22 cases, showed 2 cases of toothache, jaw pain, 2 patients with acute cerebrovascular disease is mainly 3 to arrhythmia, heart failure, cardiogenic shock is mainly those who were 5 cases, 2 cases, 2 cases. 1.3 Diagnosis of 2 cases misdiagnosed as heart failure, arrhythmia in 5 cases,[link widoczny dla zalogowanych], shock in 2 cases, 5 cases of acute gastroenteritis, 13 cases of peptic ulcer, cholecystitis in 2 cases, 2 cases of upper gastrointestinal bleeding, cerebral infarction in 3 cases, teeth 2 cases of pain, jaw pain in 2 cases. 1.4 no significant changes in ECG sT-segment elevation in 29 cases, including inferior AMI21 cases, 4 cases of anteroseptal, extensive anterior wall in 4 cases. Infarction occurred in 2 cases slow graphics. Are inferior wall AMI. Routine lead does not display graphics infarction in 2 cases, the posterior wall AMI, 2 patients with anterior wall AMI onset and appears asked infarction graphics. ST-T changes only, no Q wave in 3 cases, 2 cases of endocardial and 1 inferior reinfarction. 2 results immediately after the diagnosis of acute myocardial infarction according to the rescue, giving oxygen, analgesic, anti-platelet aggregation, anticoagulation, thrombolysis, crown expansion, emergency PCI and other treatment. 3 Discussion 3.1 misdiagnosis of silent myocardial infarction due to inadequate attention; old high pain threshold, is not sensitive to pain stimuli, response difference; usually presents with painless myocardial infarction Heart Author: 471,900 people in Henan Province Yanshi Hospital of throbbing, chest tightness, difficulty breathing,[link widoczny dla zalogowanych], supine cough, syncope, aphasia, paralysis of limbs, lungs 哕 tone, cardiac arrhythmia, shock, and misdiagnosed as cerebrovascular accident, arrhythmias, digestive diseases, in particular the combined AMI When more misdiagnosed his symptoms, painless myocardial infarction more common in elderly patients with diabetes; due to cerebrovascular accidents and serious complications such as heart failure, arrhythmia, shock cover, resulting in painless false; limited to the professional situation of clinicians , narrow thinking, ignoring the existence of his symptoms,[link widoczny dla zalogowanych], misdiagnosis common in the other performance as the first symptom AMI; AMI patients because of severe heart failure, cardiac arrhythmia caused by a sharp fall, in particular, on the basis of the original cerebral arteriosclerosis, and the brain sudden drop in blood supply to the phenomenon of the emergence of stroke. 3.2AMI patients were mostly elderly, often associated with various chronic diseases, the time when the typical clinical manifestations misdiagnosed; AMI manifested as cough, expectoration, wheezing and respiratory system diseases, while overlapping, with a single disease to explain the neglect of the existence AMI ; some patients in the upper abdominal pain, especially in inferior myocardial infarction may be misdiagnosed as acute gastroenteritis, pancreatitis, or cholecystitis; ignore the dynamic ECG and serum enzyme changes observed; some patients still do not appear or delay the emergence infarction graphics; elderly arteriosclerosis, poor blood supply to the brain, brain atrophy, slow or mental abnormalities, verbal expression difficult; combination of these symptoms in elderly patients with unexplained shock, heart failure, arrhythmia, unconsciousness, cold sweat, should take into account AMI, time line of laboratory examination room to avoid misdiagnosis. 3.3 A typical ECG is not no sT-segment elevation: the group of 29 patients, AMI was sT segment does not appear after the arched upward elevation and T wave inversion and the gradual emergence of pathological Q wave, accompanied by enzyme increased. Found in acute inferior wall AMI, the ECG limb leads as far away from the heart, the early minor changes in the limb leads not easy to argue that left some patients with inferior wall AMI Ⅱ,[link widoczny dla zalogowanych], lit, avF lead ST-segment elevation was not obvious ; only the sT-T changes, no Q waves, with parts re-infarction, only the performance of the original Q wave and deep, widening or sT-T changes. Routine lead does not show infarction graphics, such as posterior wall myocardial infarction, routine 12-lead ECG does not show, but also ignore the chest leads Vl,