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Samenvatting Postgraduaat cardiologie deel 1: Inleidende begrippen in de cardiologie
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Samenvatting postgraduaat Cardiologie deel 1: Inleidende begrippen in de cardiologie
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By: jehanabu-aljus • 1 year ago
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Inleidende begrippen in de cardiologieInhoud
1. Anatomie van het hart .................................................................................................................... 4
1.1 Bloedsomloop.......................................................................................................................... 4
1.2 Anatomie van de grote structuren .......................................................................................... 4
1.3 Anatomie van het hart ............................................................................................................ 4
2. Het hart – prikkelgeleiding en bloedcirculatie ................................................................................ 6
2.1 Inleiding ................................................................................................................................... 6
2.2 Anatomie van het hart ............................................................................................................ 6
2.2.1 Anatomie van de hartkleppen ......................................................................................... 6
2.2.2 Coronaire bloedvaten ...................................................................................................... 7
2.3 De hartslag............................................................................................................................... 9
2.3.1 Contractiele cellen ........................................................................................................... 9
2.3.2 Het geleidingssysteem ................................................................................................... 10
2.4 Bloeddruk .............................................................................................................................. 12
2.5 Autonome innervatie ............................................................................................................ 16
3. Coronaire Anatomie, Fysiologie & Pathologie .............................................................................. 18
3.1 Coronaire anatomie en fysiologie ......................................................................................... 18
3.2 Rechter coronair (RCA) .......................................................................................................... 19
3.3 Linker coronair (LMCA) .......................................................................................................... 19
3.4 Coronair veneus systeem ...................................................................................................... 20
3.5 Coronaire pathologie ............................................................................................................. 21
4. Basisprincipes ECG......................................................................................................................... 23
4.1 ECG afname ........................................................................................................................... 23
4.1.1 Standaard ECG (niet van buiten kennen hoe ze lopen, onthouden dat het 3
standaartafleidingen zijn) .............................................................................................................. 23
4.1.2 Diagnostische ECG vs monitoring .................................................................................. 23
4.1.3 Protocol ECG-afneme .................................................................................................... 23
4.2 Prikkelgeleiding ..................................................................................................................... 24
4.3 Het ECG.................................................................................................................................. 24
4.3.1 ECG registratie ............................................................................................................... 24
4.3.2 Normaal ECG ................................................................................................................. 24
4.3.3 Ritmestoornissen ........................................................................................................... 26
1
,5. ECG geleidingsstoornissen............................................................................................................. 29
5.1 Normaal geleidingssysteem .................................................................................................. 29
5.2 Sinusknoopziekte................................................................................................................... 29
5.2.1 Sino-atriale geleidingsstoornissen................................................................................. 29
5.2.2 Sinus aritmie .................................................................................................................. 30
5.2.3 Sinusknoopziekte........................................................................................................... 30
5.2.4 Tachycardia-Bradycardia Syndrome .............................................................................. 30
5.2.5 Sinusknoop gerelateerde brady (spoedgevallen) .......................................................... 30
5.3 AV-geleidingsstoornissen ...................................................................................................... 31
5.3.1 AV block (relatively common) ....................................................................................... 31
5.3.2 Reanimatie..................................................................................................................... 32
5.3.3 Tijdelijke pacing ............................................................................................................. 32
5.4 Intra-ventriculaire geleidingsstoornissen .............................................................................. 32
5.4.1 QRS-duur >100ms .......................................................................................................... 32
5.4.2 Rechter bundel .............................................................................................................. 33
5.4.3 Linker bundel ................................................................................................................. 33
5.4.4 Linker anterior hamiblock (niet op examen) ................................................................. 33
5.4.5 Linker posterior hemiblock (LAH)(niet op examen) ...................................................... 33
5.4.6 Gevorderde geleidingsstoornissen (LPH)(niet op examen) ........................................... 34
6. ECG interpreteren verdieping ....................................................................................................... 34
6.1 Standaard stappenplan ......................................................................................................... 34
7. Pathofysiologie van ritmestoornissen ........................................................................................... 39
8. Hypertensief hart- en vaatlijden ................................................................................................... 42
8.1 Pathofysiologie van hypertensie ........................................................................................... 42
8.1.1 Mogelijke oorzaken van hypertensie ............................................................................ 43
8.1.2 Diagnose van hypertensie ............................................................................................. 46
8.2 Behandeling en preventie van hypertensie .......................................................................... 51
8.2.1 Niet medicamenteuze therapie ..................................................................................... 52
8.2.2 Medicamenteus ............................................................................................................. 53
8.2.3 Therapie: keuze product................................................................................................ 57
9. Hartfalen ........................................................................................................................................ 61
8.1 Deel 1: definitie epidemiologie pathofysiologie ................................................................... 61
8.1.1 Definitie (examenvraag) ................................................................................................ 61
8.1.2 Epidemiologie ................................................................................................................ 62
8.1.3 Etiologie ......................................................................................................................... 62
8.1.4 Pathofysiologie .............................................................................................................. 63
2
,8.2 Deel 2: Diagnostiek + Evolutie in monitoring ........................................................................ 67
8.2.1 Diagnostiek .................................................................................................................... 67
8.2.2 Evolutie in monitoring ................................................................................................... 71
8.3 Deel 3: Behandeling van hartfalen ........................................................................................ 72
8.3.1 Doel................................................................................................................................ 72
8.3.2 Behandelladder ............................................................................................................. 73
8.3.3 Behandeling ................................................................................................................... 73
8.3.4 Acuut longoedeem ............................................................................................................... 78
8.3.5 Hartfalen en bejaarden ........................................................................................................ 79
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, 1. Anatomie van het hart
1.1 Bloedsomloop
Grote bloedsomloop
• Hart pompt zuurstofrijk bloed naar u lichaam. Daar wordt O2 opgenomen door weefsels.
Vervolgens gaat zuurstof arm bloed terug naar het hart.
Kleine bloedsomloop
• Hart pompt zuurstof arm bloed naar de longen. Longen voorzien het bloed van O2. Bloed
wordt terug naar het hart gepompt.
1.2 Anatomie van de grote structuren
1. Vena cava superior
2. Linker long top
3. Aorta boog
4. Longvlies/ Pleura (Pariatale pleura -> longvlies tegen de borst)
5. Arteria pulmonalis/ Truncus pulmonalis
6. Pericard
7. Apex van het hart
8. Diafragma
Hartspier :
1. Endocard
2. Myocard
3. Epycard
4. Pericardruimte met beetje vocht
5. Sereuse deel van het pericard
6. Fibrueuse deel van het pericard
1.3 Anatomie van het hart
1. A./Truncus brachio (arm) Cefalicus (hersenen)
2. Vena cava superior
3. Rechter a. pulmonalis
4. Aorta acedens
5. A./Truncus pulmonalis
6. R v. pulmonalis
7. R Atrium
8. R Coronaire a. (RCA)
9. Anterior (voorkant) cardiac vene
10. R ventrikel
11. Marginal a.
12. Small cardiac v.
13. Vena cava inferior
14. L common carotic artery
15. L a. subclavia
16. Aortaboog
17. Ligamenten arteriosum
18. L a. pulmonalis
19. L v. pulmonail
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