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Tip 2 diyabet ve atriyal fibrilasyon geçici iskemik atağa neden olabilir

Diabetes Mellitus (DM), sadece kırsal kesimde değil, kentlerde de yaygın olan kronik sorunlardan biri olmaya devam etmektedir. Kan şekeri metabolizmasının düzenlenmesi hedef noktalardan biri iken, DM ile yaşamak birinci basamak hekimlerini zorlayabilir. En az 5 yıldır DM ve hipertansiyon tanısı almış 64 yaşında kadın hasta halsizlik ve dizüri nedeni ile kliniğe başvurmuştur. Bakteriüri tespit edilmiş ve kan şekeri 550 mg/dl WBC= 12,48 CRP: 7 HbA1C: 10,4 % olarak bulgulandı. İdrar kaçırma dışında nörolojik muayenesi normaldi. DM, HT ve sistit tanısıyla hastaneye yatırıldı. Metformin 2x1gr, 1x40 mg, seftriakson 2x1gr, insülin glarjin verildi. Diyabetik hasta eğitimi verildi. İzlemde kan şekeri regülasyonu düzeldi ancak çarpıntı şikayeti ile EKG çekildi ve AF (atriyal fibrilasyon) teşhisi kondu. Tansiyonu 120/80 idi ve metoprolol infüzyonu yapıldı. INR: 1,44 sn PT=17sn kreatin=0,9 mg/dl. Kontrol EKG sinüs ritmindeydi. İyileştiği sırada dahiliye konsültasyonu yapıldı ve taburcu olması planlandı. Taburculuk işlemleri planlanırken "konuşamıyorum" diye şikayet etti. Nörolojik muayenesin sırasında, de sol kolunda kuvvet kaybı (3/5) olan hasta, söylenenleri duyabiliyor, anlayabiliyor ancak konuşamıyordu. Geçici İskemik Atak (GİA) ön tanısıyla tileri tanı ve tedavi için başka bir sağlık merkezine nakledildi. DM asla yalnız yürümez. Birinci basamak sağlık merkezlerinde hekimler, yönetilecek yeni başlangıçlı sorunların yanı sıra kronik durumların da farkında olmalıdır

Anahtar Kelimeler:

diabetes mellitus, geçici iskemik atak, birinci basamak

Type 2 diabetes and atrial fibrillation could cause transient ischemic attack

Diabetes mellitus (DM) is still one of the common chronic problems not only in rural but also the urban cities. While the regulation of blood sugar metabolism is one of the target points, living with DM can trammel primary care physicians. 64 years old female patient who was diagnosed with DM and hypertension for at least 5 years has attended the surgery for nuisance and dysuria. Bacteriuria has detected and blood sugar was 550 mg/dl WBC= 12,48 CRP: 7 HbA1C: 10,4 % Her neurologic examination was normal except she has got urinary incontinence. She was hospitalized with a diagnosis of DM, HT, and cystitis. Metformin 2x1gr, 1x 40 mg, ceftriaxone 2x1gr, and insulin glargine were ordered. Diabetic patient education has been performed. During follow-up, her blood sugar regulation has been settled but she complained of palpitation, ECG has been performed and diagnosed as AF (atrial fibrillation). Her blood pressure was 120/80 and metoprolol infusion was made. INR: 1,44 sec PT=17sn creatine=0,9 mg/dl. Control ECG was at sinus rhythm. While she was in time of recovery, internal medicine consultation has performed and she was planned to discharge. She complained about "could not talk". In her neurologic examination, her left arm has lost strength (3/5) and she could hear and understand what was told but couldn't speak. She was transferred to another health center for detection and treatment as pre-diagnose of Transient Ischemic Attack (TIA). DM never walks alone. At primary health care centers physicians should be aware of chronic conditions as well as the new onset problems to manage.

Keywords:

diabetes mellitus, transient ischemic attack, primary care,

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