HIDDEN BURDEN OF CORONARY MICROVASCULAR DISEASE IN A DIABETIC FEMALE NSTEMI PATIENT : A CASE-BASED CLINICAL PERSPECTIVE
DOI:
https://doi.org/10.31004/prepotif.v9i2.46388Keywords:
diabetes melitus, pasien perempuan, disfungsi endotel, infark miokard non-ST elevasi, penyakit mikrovaskular koronerAbstract
Penyakit mikrovaskular koroner (Coronary Microvascular Disease/CMD) semakin dikenal sebagai penyebab iskemia miokard pada pasien tanpa penyakit arteri koroner obstruktif, terutama pada perempuan dengan diabetes. Infark miokard non-ST elevasi (NSTEMI) dalam kelompok ini sering muncul dengan gejala atipikal dan temuan elektrokardiografi yang tidak spesifik, sehingga menyulitkan diagnosis dan penanganan yang tepat waktu Seorang perempuan usia 50 tahun dengan riwayat diabetes melitus dan hipertensi datang dengan keluhan nyeri dada yang berlangsung lama tanpa elevasi segmen ST pada elektrokardiogram. Evaluasi kardiak menunjukkan NSTEMI anterior, namun tidak ditemukan obstruksi pada pembuluh koroner epikardial. Karakteristik klinis dan demografis pasien mengarah pada dugaan disfungsi mikrovaskular koroner. Pasien ditatalaksana secara konservatif dengan terapi antiplatelet ganda, antihipertensi, dan pengendalian metabolik. Kasus ini menggambarkan permasalahan tersembunyi CMD pada perempuan dengan diabetes, di mana cedera iskemik dapat terjadi meskipun hasil angiografi tampak normal. CMD melibatkan disfungsi endotel, penurunan cadangan aliran koroner, dan aktivasi inflamasi, yang semakin nyata dalam kondisi diabetes. Alat diagnostik konvensional seringkali tidak memadai untuk mendeteksi CMD, sehingga diperlukan kecurigaan klinis yang tinggi. CMD perlu dipertimbangkan pada perempuan dengan diabetes yang mengalami NSTEMI, terutama jika perubahan elektrokardiografi minimal dan wilayah infark melibatkan miokard anterior. Pengakuan dini dan terapi yang ditargetkan sangat penting untuk menurunkan risiko kardiovaskular jangka panjang pada subpopulasi berisiko tinggi ini.References
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