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目的 探讨先天性单冠状动脉畸形的误诊原因及防范措施。方法 分析2022年3月至2023年10月收治的被误诊为冠心病的先天性单冠状动脉畸形患者2例的临床资料。结果 2例患者均有反复活动后胸闷、心悸病史，症状于劳累后加重，休息可好转，均有高血压病史；1例伴有糖尿病、脑梗死、心房颤动病史。多次行心电图等相关检查均提示心肌缺血性改变，颈部血管超声提示有斑块形成，血脂异常，心脏彩超未见明显异常，未行冠状动脉相关检查，均误诊为冠心病。完善相关检查并予冠状动脉造影确诊为先天性单冠状动脉畸形。误诊时间分别为5、8年。确诊后调整治疗方案，患者症状改善。分别随访2.5和1年，均无明显不适。结论 先天性单冠状动脉畸形临床少见，临床症状与冠心病相仿。及时行冠状动脉相关检查可明确诊断，不仅有利于疾病的防治及风险告知，也利于患者康复。
Abstract：Objective To investigate the causes and preventive measures of misdiagnosis of congenital single coronary artery anomaly(CAA). Methods From March 2022 to October 2023, the clinical data of 2 patients with congenital single CAA misdiagnosed as coronary heart disease(CHD) were analyzed. Results Both patients had a history of chest tightness and palpitation after repeated activities, which aggravated after exertion and improved after rest. Both patients had a history of hypertension. One patient had a history of diabetes, cerebral infarction and atrial fibrillation. Multiple electrocardiograms and other related examinations revealed myocardial ischemic changes. Cervical vascular ultrasound showed plaque formation and dyslipidemia. However, no obvious abnormality was found in cardiac color Doppler ultrasound, and no coronary artery-related examination was performed, so they were misdiagnosed as CHD. The patient was diagnosed with congenital single CAA by relevant examinations and coronary angiography. The duration of misdiagnosis was 5 and 8 years respectively.After the diagnosis was made, the patient's symptoms were improved and the effect was obvious. Up to now, there was no obvious discomfort. Conclusion Congenital single CAA is a rare disease in clinical practice and often presents with clinical symptoms, which is similar to CHD. Timely coronary artery-related examinations helps to confirm the diagnosis and is not only beneficial to disease prevention and risk notification, but also beneficial to the rehabilitation of patients.
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基本信息:
DOI：
中图分类号:R543.3
引用信息:
[1]蒋旋志,丁绍祥.先天性单冠状动脉畸形临床误诊分析[J].临床误诊误治,2025,38(12):12-16.
基金信息:
江苏省老年健康科研面上课题（LKM2023033）