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一、诊断和鉴别诊断:本例临床特点:①中年患者,突然发病,心前区剧痛,含化硝酸甘油症状不缓解;②听到心包摩擦音;③心电图 S—TV_(3-5)抬高,弓背向下,T 波直立.根据以上临床特点,须考虑以下几种疾病:1、急性心肌梗塞:患者系中年男性,突然心前区剧痛,含化硝酸甘油无效,胸骨左缘第3～4肋间可听到心包摩擦音,心电图 S—TV_(3-5)抬高等,故急性心肌梗塞应首先考虑.但从心电图衍变过程来看,虽有 S—T 段抬高,但弓背向下,不是心肌梗塞早期与 T 波融合形成的“单向曲线”,同时T 波始终直立,不符合急性心肌梗塞 T 波衍变的过程,无病理性 Q 波出现,因此,不符合急性心肌梗塞的心电图表现.部分急性心肌梗塞患者,可出现心包摩擦音,但多在病后第2～5天出现.而本例病人入院时即已出现,心电图检查无心肌梗塞图形,血清谷草转氨酶正常,故可排除急性心肌梗塞.2、急性胸膜炎:心前区疼痛和听到摩擦音应
First, the diagnosis and differential diagnosis: The clinical features of this case: ① middle-aged patients, sudden onset, precordial pain, nitroglycerin-containing symptoms do not ease; ② hear pericardial frictional; ③ ECG S-TV_ (3-5) According to the above clinical features, to consider the following diseases: 1, acute myocardial infarction: patients with middle-aged men, suddenly atrial pain, heart failure with nitroglycerin, sternal The left margin of the intercostal 3 ~ 4 can hear pericardial frictional sound, electrocardiogram S-TV_ (3-5) elevation, it should be the first consideration of acute myocardial infarction, but from the ECG evolution process, although the S-T segment elevation , But the bow back down, not the early myocardial infarction and T wave fusion formed a “one-way curve”, while T wave is always upright, does not meet the T wave of acute myocardial infarction evolution process, no pathological Q wave appears, so not In line with the ECG of acute myocardial infarction.Part of acute myocardial infarction patients, there may be pericardial rubbing sound, but more in the first 2 to 5 days after the onset of this patient has appeared on admission, ECG without myocardial infarction pattern, serum aspartate Aminotransferase normal, it can rule out acute myocardial infarction .2, acute chest Yan: chest pain and should hear the fricative