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samenvatting cardio: fysiologie (Wouters)
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volledige samenvatting van fysiologie van cardiovasculair en respiratoir stelsel (lessen van Wouters)
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bronywiedeman
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FYSIOLOGIE: cardiovasculairH1:
- kleine + grote bloedsomloop
H2: excitatie + contractie
- actiepotentiaal:
o fase 0: depolarisatie: openen Na+ kanalen + absol/relat refractair
o fase 1: snelle repolarisatie
o fase 2: plateau
o fase 3: repolarisatie
- contractie hartspiercel
o Ca2+ influx tgv AP
o Ca2+ influx tgv CICR
- relaxatie hartspiercel
o sluiten Ca2+ kan
o Ca2+ ATPasen (SR en EC)
o Na+/ Ca2+ uitwisselaar
- modulatie contractiekracht:
o inotrope factoren: contractiliteit
NOR + ADR (+): β1 (NOR ook lusitroop)
hartglycosiden (+)
snelle opeenvolging AP’s (+)
acidose (-)
o acute hypoxie: KATP kanalen
o chronische hartproblemen: Ca2+ overload
delayed/early afterdepolarisation => prematuur AP
H3: neuromusculair geleidingsweefsel
- SA: spontane depolarisatie tgv K+ efflux + 2 influx (Ib en If) => Ca2+ influx
- AV: Ca2+ influx Ca2+ entry blockers
- bundel van His + purkinjevezels: Na+ influx
- conductiesnelheid afh v grootte AP en snelheid depolarisatie
- hartritme: afh v AP freq SA cellen : chronotroop
o OS : cAMP => If + snellere Ca2+ influx
NOR + ADR : β1 (+)
PDE inhib (caffeine, theofyline, milrinone) (+)
NOR: (+) dromotroop
o PS: inhib AC (vagale tonus)
Ach: M2
o temperatuur, thyroïdhormonen
o kaliëmie: 3,5-5,5 mM
hyper: > 5,5: Em dichter bij drempel + partiële inact Na + kan (blok bij >8)
hypo: < 3: Em verder van drempel
1
, - ectopische pacemakers
- hyperexciteerbare hartcellen
- re-entry
- Wolff-Parkinson-White: bundel van Kent (+ re-entry)
- SAC’s: klop op borst/Bainbridge reflex/extrasystolen
H4: EKG
- perifere standaardafleidingen
o bipolair: DI, DII, DIII
o unipolair: aVL, aVF, AVR
- precordiale standaardafleidingen
o unipolair: V1-V6
- gespecialiseerde afleidingen: unipolair slokdarm/hart, bipolair precordiaal
- elektroden:
o uiteinden spier: dipool
o midden spier (loodrecht): cos hoek tuss elektroden en pool
- P: depolar atria
- PQ/R- segment: contractie atria
- PQ/R interval: AV geleiding
- QRS: depolar ventrikels
- ST segment: contractie ventrikels (plateau)
- QT interval: elektrische systole
- T: repolaris ventrikels
- elekt as hart: (-30°, 90°)
o >90°: R as afwijking: hypertrofie R hart
o >30°: L L
- wet van Einthoven: DII = DI + DIII
H5: hartcyclus: systole + diastole (75/min)
- diastole: 500 ms
o snelle relaxatie (actief) => openen mitralisklep isovolumetrisch
o vullingsfase
snel: 90% VEDV
traag = diastase (passief): 10% VEDV
o atriale systole = atriale kick => afh v HF en ventrikelcompliantie
- systole: 300 ms
o snelle aanspanningsfase => sluiten mitralis + openen ao klep isovolumetrisch
o ejectiefase: SV = VEDV – VESV
diast => syst druk
momentum
rebound => ao klep sluit + dicrotic notch
- druk-volume lus: compliantie + contractiliteit
- harttonen
- hartgeruisen :
2
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