KOMBINASI KASUS KOMPLEKS : DISEKSI KORONER SPONTAN DAN STEMI PADA WANITA MUDA DENGAN SINDROM NEFROTIK AKTIF
DOI:
https://doi.org/10.31004/jkt.v6i4.51991Keywords:
infark miokard dengan elevasi segmen ST, Dewasa Muda, fungsi ginjalAbstract
Infark miokard dengan elevasi segmen ST (STEMI) jarang terjadi pada individu berusia muda. Sindroma Nefrotik (SN) dengan karakteristik hiperlipidemia, hipoalbuminemia serta edema dapat menciptakan suatu kondisi hiperkoagulopati sistemik yang meningkatkan risiko tromboemboli arteri secara signifikan. Namun, manifestasinya sebagai STEMI akut masih merupakan sebuah tantangan diagnostik dan terapeutik. Seorang wanita berusia 30 tahun datang ke unit gawat darurat dengan keluhan pusing, sinkop 6 jam SMRS disertai nyeri dada, ulu hati dan bahu sejak >12 jam SMRS. Pasien dikenal dengan riwayat sindrom nefrotik, gambaran EKG 12 sadapan menunjukkan gambaran STEMI inferoposterior late onset dengan episode transient blok atrioventricular total, pemeriksaan marker enzim jantung HS Trop I menunjukkan hasil > 40.000 dengan status nefrotik aktif ( protein urin +3). Tindakan angiografi koroner dilakukan dengan support alat pacu jantung temporer menunjukkan adanya gambaran total oklusi di bagian proksimal arteri koroner kanan (RCA) serta gambaran diseksi koroner spontan. Tindakan Percutaneus Coronary Intervention (PCI) dilakukan dengan hasil restorasi aliran pembuluh darah yang baik. Keadaan hiperkoagulopati pada SN, yang dicirikan oleh kehilangan protein antikoagulan seperti antitrombin III melalui urin dan peningkatan sintesis faktor pro-koagulan oleh hati dianggap sebagai salah satu mekanisme utama terjadinya trombosis koroner in-situ. Namun penyebab abnormalitas koroner lainnya seperti peningkatan plak aterosklerotik yang signifikan, aneurisma koroner, serta diseksi spontan koroner juga menjadikan patofisiologi diantara keduanya menjadi tumpang tindih.References
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