Cause Analysis and Preventive Measures of Misdiagnosis of Acute Myocar-dial Infarction

WEI Xiaopan; GAO Junfeng; WANG Lefeng; LIU Yu; WANG Huimin

doi:10.3969/j.issn.1002-3429.2025.08.005

Abstract：Objective To analyze the causes of misdiagnosis of acute myocardial infarction(AMI)and to explore the effective countermeasures to reduce misdiagnosis,so as to improve the accuracy of clinical diagnosis.Methods The data of 3 patients with AMI misdiagnosed and then treated from December 2022 to December 2023 were retrospectively analyzed.Re-sults One patient presented with sudden retrosternal compression pain accompanied by sweating,and had no history of coro-nary heart disease(CHD).A 12-lead electrocardiogram(ECG)examination showed no obvious abnormality,and the patient was initially diagnosed as gastroesophageal reflux disease(GERD).After ineffective anti-acid therapy,the symptoms wors-ened the next day.After re-examination of ECG,myocardial necrosis markers,and coronary angiography,it was diagnosed as acute anterior wall myocardial infarction.One patient complained of severe upper abdominal pain accompanied by nausea and vomiting and had no history of CHD.Acute inferior myocardial infarction was confirmed by further ECG,markers of myocardi-al necrosis and coronary angiography after routine treatment.One patient was diagnosed with acute pulmonary embolism due to sudden dyspnea and severe chest pain with radiating back pain.After pulmonary embolism was ruled out by chest CT angiogra-phy,acute inferior myocardial infarction was confirmed by ECG,markers of myocardial necrosis,and coronary angiography.The misdiagnosis of 3 patients lasted 30,10,and 6 h,respectively.All 3 patients received percutaneous coronary intervention after diagnosis,and the prognosis was good.Conclusion The misdiagnosis of AMI is mainly due to the diversity and atypia of its clinical manifestations.The important measures to reduce the misdiagnosis of this disease included improvement of the vigilance of medical staff,standardization of the diagnosis and treatment process,multiple examinations of ECG and myocardi-al necrosis markers and cooperation with various disciplines.