- 期刊
Acute Myocardial Infarction Presenting without Chest Pain
無胸痛之急性心肌梗塞
摘要
目的：本研究的目的在提高急診醫師對無胸痛急性心肌梗塞病人的警覺。 方法：本研究以回溯性病歷審查之方式，蒐集中台灣某醫學中心於一年中出院診斷為急性心肌梗塞之病人（診斷碼為ICD-9-CM Codes 410.xx），統計分析其急診就醫時之資料包括主訴。 結果：從2001年11月l日起至2002年10月31日止共有284份有效病歷。100名(35.2%)病人主訴裡無胸痛，其中主訴症狀以氣促5l(18%)、腹部不適31(10.9%)、及意識改變18(6.3%)為主。其他症狀包括：發燒、頭暈或昏厥、心悸、咳嗽。年長者（平均年齡73歲，從50到96歲）沒有胸痛的比率較高。女性亦較多沒有胸痛症狀。 結論：本研究之結果，急性心肌梗塞病人不以胸痛表現之比率與其他研究並無不同。但非胸痛病人之症狀與其他研究結果相較有顯著差異，我們的病人都在50歲以上，較多病人有腹部不適與意識改變。急診科醫師應高度注意到此項事實，及早診斷無痛性急性心肌梗塞，避免不必要之延遲及誤診。
並列摘要
Objective: Increase awareness of acute myocardial infarction (MI) in patients without chest pain as a presenting symptom in the emergency department (ED). Methods: This is a retrospective study over a one-year period at a medical center in central Taiwan. Patients with a discharge diagnosis of acute myocardial infarction based on ICD-9-CM codes 410.xx were enrolled in a chart review. Data collected include presenting symptoms in the ED. Results: From November 2001 to October 2002, 284 patients were admitted to the hospital with acute MI, of whom 100 (35.2%) presented without chest pain. Common symptoms in these patients included shortness of breath in 51 (18%), abdominal distress in 31 (10.9%), and impaired consciousness in 18 (6.3%). Other symptoms included fever, dizziness or syncope, palpitation and cough. Patients without chest pain were significantly older than those with typical symptoms, with a mean age of 73 years (ranging from 50 to 96). Women were more likely to present without chest pain. Conclusion: Differences were noted as to the type of initial presentation compared to other reports (Patients with an atypical presentation were found to be older than 50 years, with higher percentages of abdominal distress and change in consciousness). Heightened awareness of these facts on the part of the emergency physician can avoid unnecessary delays or missed diagnosis of acute MI.