Analysis of ECG Misdiagnosis of Atypical Acute Myocardial Infarction

DENG Zhengchao; LI Xingming; CHEN Dehua

doi:10.3969/j.issn.1002-3429.2024.08.001

Abstract：Objective To investigate the causes and preventive measures of early Electrocardiogram(ECG)misdiag-nosis of atypical acute myocardial infarction(AMI).Methods The clinical data of 2 patients with misdiagnosed atypical AMI admitted from January 2022 to February 2023 were retrospectively analyzed.Results One patient presented with fever,chest tightness,palpitation,cough and general fatigue for 1 d.ECG showed ST segment depression in leadsⅡ,Ⅲand aVF,with low and flat T waves and sinus arrhythmia,and it was misdiagnosed as myocarditis.The patient was treated symptomati-cally without improvement,and AMI was diagnosed after reexamination of ECG and myocardial enzyme.One patient was ad-mitted to hospital for chest pain and syncope for 2 h.No ST-T or abnormal Q-wave changes were found in the ECG,and right ventricular hypertrophy was suggested.AMI was confirmed by myocardial enzyme,cardiac ultrasound and coronary angiogra-phy.The duration of misdiagnosis was 3 d and 6 h.One patient received conventional medication treatment,and one patient underwent percutaneous coronary intervention.The prognosis was good after operation.Conclusion It is more likely to mis-diagnose patients with atypical AMI because there is no obvious symptom of chest pain nor typical manifestations or normal manifestations in early stage on ECG.Strengthening the understanding of atypical AMI,being alert to the patients with high risk factors,being familiar with the characteristics of dynamic changes of ECG,paying attention to monitoring of dynamic ECG,and combining clinical symptoms and myocardial enzymes to analyze the condition are helpful for early diagnosis and treatment.