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Eigen cursus/ samenvatting module cardiologie
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Eigen cursus / samenvatting van module caridologie Geslaagd 14/20 eerste zit
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Priscillia Angela CosentinoCARDIOLOGIE
Examenvraag: Ritme en geleidingsstoornis + casus ( over behandeling of traject)
INHOUDSTAFEL
HOOFDSTUK 1 : Anatomie en fysiologie v/h hart ................................................................................... 6
1) Ligging v/h hart i/d thorax .......................................................................................................... 6
2) Anatomie v/h hart ....................................................................................................................... 6
1. Microstructuur v/h hart .......................................................................................................... 7
3) Het hart als pomp ....................................................................................................................... 8
1. Hartcyclus................................................................................................................................ 8
1. De drukcurven ......................................................................................................................... 9
4) De bloedvoorziening v/h hartspier ............................................................................................. 9
1. Coronaire vaten in detail ........................................................................................................ 9
2. Factoren die de vulling v/d coronaire arteriën zullen beïnvloeden...................................... 10
3. Samenvattend : factoren ...................................................................................................... 11
1) Inleiding..................................................................................................................................... 12
2) Depolarisatie en repolarisatie v/e normale cel......................................................................... 12
3) Spontane depolarisatie bij de cellen v/d sinusen AV-knoop .................................................... 12
1. De hartfrequentie ................................................................................................................. 13
4) Extracardiale bezenuwing v/h hart ........................................................................................... 13
HOOFDSTUK 2 : Het ECG praktisch benaderd ....................................................................................... 14
1) Het ECG : Depolarisatie v/d atria & ventirkels .......................................................................... 14
2) Het ECG ..................................................................................................................................... 15
3) Oefening ECG ............................................................................................................................ 15
4) Het 12-afleidingen ECG ............................................................................................................. 15
1. De basisafleidingen (I,II,III) via Driehoek van einthoven....................................................... 16
2. De 3 versterkte afleidingen ( aVL, aVR, Avf) ......................................................................... 16
3. De basis- en versterkte afleiding ........................................................................................... 16
5) De elektrische hart-as ............................................................................................................... 17
1. Praktisch ................................................................................................................................ 17
2. Praktische benadering van de interpretatie van de hart-as: ................................................ 18
3. Berekening v/d hart-as uit I en AVF ...................................................................................... 18
4. Voorbeeld berekening .......................................................................................................... 18
5. De afwijkende elektrische hart-as ........................................................................................ 19
6. Voorbeelden afwijkende elektrische hart-as ........................................................................ 19
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,Priscillia Angela Cosentino
6) De 6 unipolaire precordiale afleidingen (V1-V6) ...................................................................... 20
7) De 12 verschillende afleidingen ................................................................................................ 20
8) Stappenplan bij het analyseren van ECG .................................................................................. 20
1. Hartritme............................................................................................................................... 20
2. Hartfrequentie ...................................................................................................................... 20
3. De geleidingstijden................................................................................................................ 21
4. De hart-as .............................................................................................................................. 22
5. De P-top ................................................................................................................................ 23
6. Het QRS complex................................................................................................................... 23
7. Het ST-segment (ischemie) ................................................................................................... 23
8. De T-top ................................................................................................................................ 23
HOOFDSTUK 3 : CORONAIRE VAATZIEKTEN.......................................................................................... 24
1) Atherosclerose .......................................................................................................................... 24
2) Angina pectoris = pijn op de borst ............................................................................................ 25
1. Klachtenpatroon ten gevolge van myocardiale ischemie ..................................................... 25
3) Stabiele/inspanning angor ........................................................................................................ 26
1. Klachtenpatroon ................................................................................................................... 26
2. Pathofysiologie...................................................................................................................... 26
3. NYHA Functional Capacity Classification............................................................................... 26
4. Diagnose................................................................................................................................ 26
5. Prognose ............................................................................................................................... 28
6. Behandeling .......................................................................................................................... 28
4) Prinzmetal of vasospastische angina ........................................................................................ 32
5) Acute coronaire syndromen (ACS) ............................................................................................ 33
1. Pathofysiologie...................................................................................................................... 33
2. Samenvattend : Onstabiele angor ........................................................................................ 33
3. Het acuut myocardinfarct ..................................................................................................... 33
HOOFDSTUK 4 : ritme-en geleidingsstoornissen vo/d kinesitherapeut ............................................... 42
1) Inleiding..................................................................................................................................... 42
2) De sinusknoop en de atria ........................................................................................................ 42
1. De sinustachycardie .............................................................................................................. 42
2. De sinusbradycardie.............................................................................................................. 43
3. De sinusaritmie ..................................................................................................................... 44
4. De boezemritme of sinus coronarius ritme .......................................................................... 44
5. De PAT of paroxysmale atriale tachycardie .......................................................................... 45
6. Supra ventriculaire, atriale of boezem extrasystole (SVES) .................................................. 45
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,Priscillia Angela Cosentino
7. De voorkamerflutter ............................................................................................................. 46
8. De voorkamerfibrillatie (VKF) ............................................................................................... 47
9. De wandering pacemaker ..................................................................................................... 48
10. Het AV-RITME bij sinusarrest ............................................................................................ 48
11. De AV-junctionele extrasystole ......................................................................................... 49
3) De AV-knoop ............................................................................................................................. 49
1. Inleiding : Het atrio-ventriculair blok of AV-blok .................................................................. 49
2. Het 1ste AV blok ..................................................................................................................... 49
3. Het 2e graads AV blok (Mobitz Type I of Wenckebach) ....................................................... 50
4. Het 2de graads AV blok ( Morbitz Type II).............................................................................. 50
5. Het 2de AV blok ...................................................................................................................... 50
6. Het 3de graads of compleet AV-blok...................................................................................... 51
4) De ventrikels ............................................................................................................................. 51
1. Het prematuur ventriculair complex (PVC) of ventriculaire extrasystole (VES) ................... 51
2. Ventriculaire tachycardie (VT) .............................................................................................. 53
3. Ventrikelfibrillatie (VF) .......................................................................................................... 54
4. Asystolie ................................................................................................................................ 55
5. Het linkerbundeltak blok (LBBB, Left Bundle Branch block) ................................................. 55
6. Het Rechterbundeltakblok (RBBB, Right Bundle Branch block)............................................ 55
5) ECG-oefeningen ........................................................................................................................ 56
HOOFDSTUK 5 : hartklepaandoeningen ............................................................................................... 58
1) Inleiding..................................................................................................................................... 58
2) Acuut gewrichtsreuma .............................................................................................................. 58
3) Aorta(klep)stenose ( komt vrij frequent voor).......................................................................... 58
4) Aortaklep-insufficiëntie ............................................................................................................ 59
5) Mitralisklep-stenose ................................................................................................................. 60
6) Mitralis-insufficiëntie ................................................................................................................ 60
HOOFDSTUK 6 : hartfalen ..................................................................................................................... 62
1) Definitie..................................................................................................................................... 62
2) Incidentie en mortaliteit ........................................................................................................... 62
3) Evolutie en prognose ................................................................................................................ 63
4) Diagnose.................................................................................................................................... 63
5) Oorzaken ................................................................................................................................... 63
6) Indeling van hartfalen volgens ejectiefractie ............................................................................ 64
7) Fysiologie van hartfalen met een gereduceerde ejectiefractie ................................................ 64
1. Factoren die de regulatie v/h slagvolume beïnvloeden ....................................................... 64
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, Priscillia Angela Cosentino
2. Dalend mechanisme bij hartfalen met gereduceerde ejectiefractie .................................... 65
8) Compensatoire mechanismen .................................................................................................. 65
9) Terminologie ............................................................................................................................. 66
10) Niet-cardiale oorzaken van hartfalen-rationale.................................................................... 67
1. Een gestoorde endotheelfunctie & vasomotoriek................................................................ 67
2. Abnormaliteiten i/d spiersmanestelling ............................................................................... 68
3. Herverdeling v/d cardiac output ........................................................................................... 68
4. Ergoreflex activatie ............................................................................................................... 68
11) Behandeling .......................................................................................................................... 68
HOOFDSTUK 7 : hartrevalidatie ............................................................................................................ 70
1) Fysieke activiteit : primaire preventie ...................................................................................... 70
1. Aanbevelingen & effecten .................................................................................................... 71
2) Revalidatie en secundaire preventie......................................................................................... 71
1. Effecten van cardiale revalidatie........................................................................................... 72
3) Praktische aspecten van cardiale revalidatie ............................................................................ 73
1. FASE 1 : Pre-operatieve kinesitherapie ................................................................................. 73
2. FASE 1A en post-operatieve kinesitherapie .......................................................................... 73
3. FASE 2 : multidisciplinaire ambulante revalidatie ................................................................ 73
4) Trainingsintensiteit bij duurtraining van hartfalen ................................................................... 76
1. De inspanningsproef met spirometrie (adem, gasanalyse) .................................................. 76
2. De inspanningsproef zonder spirometrie (adem gasanalyse) .............................................. 80
3. Opmerkingen bij de berekening v/d trainingshartfrequentie .............................................. 81
5) Revalidatie van patiënten met hartfalen .................................................................................. 84
1. Aanbevelingen voor revalidatie van patiënten met hartfalen.............................................. 85
2. Effecten van revalidatie van patiënten met hartfalen .......................................................... 86
3. Enkele praktische aspecten van revalidatie van patiënten met hartfalen ........................... 86
HOOFDSTUK 8 : RISICOFACTOREN VOOR HART- EN VAATZIEKTEN ...................................................... 87
1) Atherosclerose .......................................................................................................................... 87
2) Waarom is risicostratificatie zo belangrijk? .............................................................................. 87
3) Leeftijd ...................................................................................................................................... 87
4) Geslacht .................................................................................................................................... 87
5) Genetische factoren – familiale predispositie .......................................................................... 88
6) Afkomst & etniciteit .................................................................................................................. 88
7) Roken ........................................................................................................................................ 88
8) Bloeddruk – hypertensie ........................................................................................................... 89
9) Lipiden ....................................................................................................................................... 89
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