Analysis of misdiagnosed cases of tuberculosis with lung cancer, vomiting, or diarrhea in 10 Yu Tu cases, six cases exhibited left shoulder radiating pain in 12 cases (left upper extremity numbness in four cases). The ECG showed acute inferior wall myocardial infarction, and two cases had acute anteroseptal myocardial infarction. Three cases experienced frequent ventricular contractions or atrial contractions. 1.2.1.3 Nervous system symptoms were mainly present in two cases. Symptoms included sudden headache, localization signs, and negative pathological reflexes; one case resulted in coma, and the ECG showed a large area of anterior myocardial infarction. 1.2.1.4 Other manifestations included sore throat in one case, toothache in one case, leading to delayed diagnosis of myocardial infarction until symptoms increased, such as chest tightness, sweating, and blood pressure drop. ECG results indicated acute anterior septal and inferior wall myocardial infarction for definitive diagnosis. 1.2.2 Atypical ECG: Among atypical ECG cases, two cases were identified. One case presented coughing, wheezing, and inability to lie supine, diagnosed as acute left ventricular failure; the ECG showed rapid atrial fibrillation. Another case presented palpitations as the main symptom, and the ECG showed frequent ventricular premature contractions. Initially, no ST-segment elevation was observed in the ECGs of both cases.
The study proposed that abnormal Q waves are electrocardiographic signs of coronary occlusion. Clinically, abnormal Q waves serve as an important basis for diagnosing acute myocardial infarction. Abnormal Q waves, also known as pathological Q waves, have a width of 0.04 seconds and depth greater than 0.25R wave. The Q waves in the two patients upon admission were extremely small, not meeting the diagnostic criteria for pathological Q waves. However, dynamic observation revealed that the Q waves gradually deepened to meet the diagnostic criteria. Additionally, serum creatine kinase levels were exponentially increased multiple times, confirming the diagnosis of myocardial infarction. During treatment, patients were placed on absolute bed rest, provided oxygen, ECG monitoring, vital signs monitoring, effective sedation and analgesia, intravenous nitroglycerin therapy, improvement of heart function, and control of arrhythmia treatments. Seven cases underwent PIEA treatment, one patient died due to complications of heart failure, and there were no stent placements in cases of sudden death.
Currently, the incidence of acute myocardial infarction is increasing, with 15% to 20% of cases presenting non-painful symptoms. Acute myocardial infarction in patients often exhibits atypical clinical manifestations or involves atypical diseased areas. Routine lead electrocardiograms lack direct signs of myocardial infarction or are combined with other ECG changes that mask the diagnosis of myocardial infarction, leading to clinical misdiagnosis. Therefore, elderly patients presenting with difficulty in breathing, nausea, vomiting, abdominal pain, diarrhea, headache, dizziness, and coma should undergo routine ECG to avoid missed diagnoses of acute myocardial infarction. Once ECG lacks signs of myocardial infarction, it is crucial to monitor the ECG over two days, paying attention to Q-wave changes. Monitoring cardiac enzymes or troponin I is recommended.