案例#1
65岁男性患者,有吸烟、高血压和外周血管病史,在过去1周内诉胸部不适频率和程度增加。患者主诉过去步行 100 米后感胸部疼痛,但现在走路超过 50 米即出现症状。疼痛放射至左颈部,需休息更长时间方能缓解。
案例#2
45岁女性患者,青少年时诊断为1型糖尿病,于急诊室就诊时主诉因腹痛、恶心和气短而从睡梦中醒来。
其他表现
不稳定型心绞痛发作时可无胸痛,或表现为不典型、非特异性症状,特别是在年轻或老人群;女性患者;或合并糖尿病、痴呆和肾功能衰竭的患者中。[1]Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.http://eurheartj.oxfordjournals.org/content/37/3/267.longhttp://www.ncbi.nlm.nih.gov/pubmed/26320110?tool=bestpractice.com[4]Erhardt L, Herlitz J, Bossaert L, et al. Task force on the management of chest pain. Eur Heart J. 2002;23:1153-1176.http://eurheartj.oxfordjournals.org/cgi/reprint/23/15/1153http://www.ncbi.nlm.nih.gov/pubmed/12206127?tool=bestpractice.com[5]Canto JG, Fincher C, Kiefe CI, et al. Atypical presentations among Medicare beneficiaries with unstable angina pectoris. Am J Cardiol. 2002;90:248-253.http://www.ncbi.nlm.nih.gov/pubmed/12127612?tool=bestpractice.com[6]Culic V, Eterovic D, Miric D, et al. Symptom presentation of acute myocardial infarction: influence of sex, age, and risk factors. Am Heart J. 2002;144:1012-1017.http://www.ncbi.nlm.nih.gov/pubmed/12486425?tool=bestpractice.com不典型症状包括呼吸困难、消化不良、眩晕、晕厥(通常与剧烈疼痛有关)、出汗和乏力。