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急性心肌梗塞(AMI)典型病例易诊断,但有些出现特殊的临床表现,应提高警惕。以免误诊误治。我院1991年～1993年收治AMI病人76人,其中4例有特殊的临床表现,为提高对AMI表现复杂性的认识,提高抢救成功率,报告如下: 例1,以消化道出血为特征。男,46岁。因呕血便血1天,心前区疼痛2小时来院。6年前患胃溃疡已治愈。一天前突然恶心呕吐出咖啡色胃内容物,约700ml,排黑色大便约50g。2小时前心前区压榨性疼痛,闷气。BP8/5kPa。两肺(一),心音低,早搏1～2次/分。Hb6g,RBC2.1×10~(12)/L,ECG前壁梗塞,室性早搏,GOT240u。止血、静点甲氰咪胍及AMI综合治疗,29天出院。
Acute myocardial infarction (AMI) typical cases of diagnosis, but some special clinical manifestations, should be vigilant. To avoid misdiagnosis and mistreatment. Our hospital from 1991 to 1993 admitted 76 patients with AMI patients, of which 4 cases have a special clinical manifestations, in order to improve the understanding of the complexity of AMI performance and improve the success rate of rescue, the report is as follows: Example 1, characterized by gastrointestinal bleeding. Male, 46 years old. Because of vomiting blood in the stool 1 day, precordial pain 2 hours to hospital. 6 years ago suffering from gastric ulcer has been cured. Suddenly nausea vomited a day before the content of brown stomach, about 700ml, row of black stool about 50g. 2 hours ago precordial pressure pain, stuffy. BP8 / 5kPa. Two lungs (a), low heart sound, premature beats 1 to 2 beats / min. Hb6g, RBC2.1 × 10-12 / L, ECG anterior wall infarction, ventricular premature beats, GOT240u. Stop bleeding, intravenous cimetidine and AMI combined treatment, 29 days discharged.