Kutz I, Weiser M, David D
Psychiatric Services, Meir General Hospital, Kfar Saba, Israel.
Isr J Psychiatry Relat Sci. 1997;34(4):311-4.
The disturbed communication of the acutely psychotic patient with Emergency Room (ER) personnel can occasionally lead to a missed or delayed diagnosis of acute myocardial infarction. Conversely, miscommunication may also lead to a false positive diagnosis of acute myocardial ischemia or infarction. We describe a patient who failed to report lithium ingestion because of his psychotic and toxic state. Moreover, the patient was agitated and was treated with intramuscular haloperidol. These factors produced electrocardiographic changes due to the lithium and a rise in serum creatine kinase due to the intramuscular haloperidol, two criteria which could mislead an inexperienced observer to make the false diagnosis of acute myocardial ischemia or infarction. Lithium related electrocardiographic abnormalities and the causes for elevated creatine kinase isoenzymes are reviewed.
急性精神病患者与急诊室（ER）工作人员之间沟通不畅，有时可能导致急性心肌梗死的漏诊或误诊。相反，沟通失误也可能导致急性心肌缺血或梗死的假阳性诊断。我们描述了一名患者，由于其精神病态和中毒状态，未能报告锂摄入情况。此外，该患者烦躁不安，接受了肌肉注射氟哌啶醇治疗。这些因素导致了锂引起的心电图变化以及肌肉注射氟哌啶醇引起的血清肌酸激酶升高，这两个标准可能会误导缺乏经验的观察者做出急性心肌缺血或梗死的错误诊断。本文回顾了锂相关的心电图异常以及肌酸激酶同工酶升高的原因。
