Summary
Samenvatting - Hart En Vaten
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Een samenvatting van Hart en Vaten 1, gegeven in het eerste semester van Ba2 gegeven door H. Heidbuchel en enkele gastprofessoren
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By: mariejulie2x • 7 months ago
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Ba2: Hart & Vaten 1INTRODUCTIE: HET CARDIOVASCULAIR SYSTEEM ............................................................. 6
Unicellulair organisme ................................................................................................................................................... 6
Circulatie ....................................................................................................................................................................... 6
Het cardiovasculair systeem .......................................................................................................................................... 6
Schikking van de organen/vaatbedden .......................................................................................................................... 7
Bloeddoorstroom doorheen het hart............................................................................................................................. 7
Verband druk, debiet en vaatweerstand ....................................................................................................................... 7
Distributie van het bloedvolume ................................................................................................................................... 8
Vasculair systeem .......................................................................................................................................................... 8
Wederzijdse afhankelijkheid ......................................................................................................................................... 8
Regulatie ....................................................................................................................................................................... 8
Regeling van de arteriële bloeddruk .............................................................................................................................. 9
HARTFUNCTIE I– HARTCYCLUS ............................................................................................ 10
Bloedstroom doorheen het hart .................................................................................................................................. 10
Autonome innervatie van het hart .............................................................................................................................. 10
De hartcyclus ............................................................................................................................................................... 11
Hartausculatie ............................................................................................................................................................. 15
HARTFUNCTIE II – HARTDEBIET EN ZIJN DETERMINANTEN .......................................... 16
Hartdebiet ................................................................................................................................................................... 16
Hartslag & hartdebiet .................................................................................................................................................. 17
HARTFALEN – FYSIOPATHOLOGIE EN KLINIEK .................................................................. 24
Algemeen .................................................................................................................................................................... 24
Hartfalen ..................................................................................................................................................................... 24
Oorzaken van hartfalen ............................................................................................................................................... 25
Morbiditeit en mortaliteit door hartfalen .................................................................................................................... 26
Natuurlijk ziekteverloop hartfalen ............................................................................................................................... 26
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,Adaptatiemechanismen............................................................................................................................................... 26
Klachten ...................................................................................................................................................................... 28
Linker hartfalen: klinische manifestaties ..................................................................................................................... 28
Hartfalen: Klinische tekens .......................................................................................................................................... 29
RX Thorax .................................................................................................................................................................... 30
Acuut longoedeem ...................................................................................................................................................... 30
Rechter hartfalen ........................................................................................................................................................ 31
Echocardiografie .......................................................................................................................................................... 31
Behandeling hartfalen ................................................................................................................................................. 32
VASCULAIRE FUNCTIE I – ARTERIEEL .................................................................................. 36
Anatomie en functie .................................................................................................................................................... 36
Arteriële bloeddruk ..................................................................................................................................................... 38
Systeemvaatweerstand ............................................................................................................................................... 42
VASCULAIRE FUNCTIE II – ENDOTHEEL ............................................................................... 47
Opbouw en functie – algemeen ................................................................................................................................... 47
Functies ....................................................................................................................................................................... 47
Structuur ..................................................................................................................................................................... 47
Elektrofysiologie en Ca²+ regeling ................................................................................................................................ 48
Endotheel-afhankelijke relaxatie ................................................................................................................................. 49
Moduleren van de vaattonus....................................................................................................................................... 49
Hemostatische werking ............................................................................................................................................... 50
Gapvorming, oedeem en WBC migratie bij inflammatie .............................................................................................. 50
Angiogenese ................................................................................................................................................................ 51
Atherosclerose ............................................................................................................................................................ 52
VASCULAIRE FUNCTIE III – VENEUS ..................................................................................... 53
Veneuze druk .............................................................................................................................................................. 53
Veneuze terugkeer en hartdebiet ................................................................................................................................ 55
NEUROHUMORALE CONTROLE VAN HART EN CIRCULATIE I ....................................... 59
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,Inleiding ...................................................................................................................................................................... 59
Controle van het autonoom zenuwstelsel ................................................................................................................... 59
Controle via de humorale factoren .............................................................................................................................. 67
‘Alles hangt aan elkaar’ ............................................................................................................................................... 69
NEUROHUMORALE CONTROLE II – CASUS SYNCOPE ....................................................... 70
Syncope ....................................................................................................................................................................... 70
Oorzaken syncope ....................................................................................................................................................... 71
Syncope: etiologie ....................................................................................................................................................... 75
Evaluatie syncope ........................................................................................................................................................ 75
NEUROHUMORALE CONTROLE III – INSPANNING ............................................................ 78
Cardiovasculaire veranderingen tijdens inspanning ..................................................................................................... 78
ORGAANDOORBLOEDING I – ORGAANPERFUSIE ............................................................... 82
Distributie van het hartdebiet over de organen ........................................................................................................... 82
ORGAANDOORBLOEDING II – CORONAIRE CIRCULATIE ................................................. 85
Coronaire arteriën ....................................................................................................................................................... 85
Coronaire circulatie ..................................................................................................................................................... 86
Coronaire stenose ....................................................................................................................................................... 90
Endotheeldysfunctie .................................................................................................................................................... 94
Stabiele angina pectoris .............................................................................................................................................. 94
ORGAANDOORBLOEDING III – ANDERE ORGAANCIRCULATIE ...................................... 98
Cerebrale circulatie...................................................................................................................................................... 98
Spiercirculatie ............................................................................................................................................................ 100
Huidcirculatie ............................................................................................................................................................ 101
Splanchnische circulatie............................................................................................................................................. 103
Renale circulatie ........................................................................................................................................................ 103
Longcirculatie/pulmonale circulatie .......................................................................................................................... 105
Cardiovasculair systeem en ruimtevaart .................................................................................................................... 110
Cardiovasculair systeem ............................................................................................................................................ 111
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, Foetale circulatie ....................................................................................................................................................... 112
MICROCIRCULATIE................................................................................................................. 113
Functies ..................................................................................................................................................................... 113
Doorbloeding capillairen ........................................................................................................................................... 113
Transport doorheen de capillaire wand: 4 processen ................................................................................................ 113
Oedeemvorming ........................................................................................................................................................ 117
Regeling van de capillaire druk .................................................................................................................................. 119
Lymfevaten ................................................................................................................................................................ 119
ELEKTRISCHE ACTIVITEIT VAN HET HART ....................................................................... 121
Membraan exciteerbaarheid ..................................................................................................................................... 121
Cardiaal actiepotentiaal............................................................................................................................................. 127
Van actiepotentiaal naar P-QRS-T .............................................................................................................................. 134
Van actiepotentiaal naar ECG .................................................................................................................................... 135
Modulatie van het actiepotentiaal en klinische implicaties ....................................................................................... 139
Casus-uitleg en discussie ........................................................................................................................................... 144
MEDISCHE FYSICA CIRCULATIE: DRUK, FLOW & WEERSTAND .................................. 146
Doel circulatie............................................................................................................................................................ 146
Drukverschil, potentiaalverschil, weerstand en stroom ............................................................................................. 146
Elasticiteit .................................................................................................................................................................. 154
Ruimtevaart .............................................................................................................................................................. 160
KLINISCH ONDERZOEK – HARTTONEN EN HARTGERUIS .............................................. 161
Klinisch onderzoek..................................................................................................................................................... 161
ACLS ............................................................................................................................................ 168
Elektrische therapie bij ritmestoornissen: cardioversie/defibrillatie ......................................................................... 168
Plotse dood ............................................................................................................................................................... 169
Life support ............................................................................................................................................................... 170
BLOEDVATEN – ANATOMIE ................................................................................................... 177
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