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Samenvatting bloedsomloop 1e master deel 1

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  • Course
  • Bloedsomloop
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  • Katholieke Universiteit Leuven (KU Leuven)

Samenvatting van het vak bloedsomloop van de eerste master geneeskunde. Dit is enkel deel 1, omdat het volledige bestand te groot is om in 1 keer te uploaden. Deel 2 is ook beschikbaar. Beide delen kunnen ook aangekocht worden in een voordeelbundel. Bevat alle te kennen leerstof op basis van handbo...

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  • September 5, 2023
  • 130
  • 2022/2023
  • Summary

Subjects

  • bloedsomloop
  • hart en vaat
  • master geneeskunde
  • ku leuven

Written for

  • Katholieke Universiteit Leuven (KU Leuven)
  • Geneeskunde
  • Bloedsomloop
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HART- EN VAATPATHOLOGIE
INHOUDSOPGAVE

Anatomie en fysiologie van het vaatstelsel ................................................................................................... 11
Normale anatomie, structuur en functie ........................................................................................................... 11
Arteries ..................................................................................................................................................... 11
Endotheel ................................................................................................................................................. 11
Venen ....................................................................................................................................................... 11
Lymfestelsel.............................................................................................................................................. 12
Anatomie voor klinisch gebruik ......................................................................................................................... 13

1. Semeiologie vaat....................................................................................................................................... 17
H1a: Klinisch onderzoek (Fourneau).................................................................................................................. 17
Arterieel lijden: inleiding .............................................................................................................................. 17
Chronische arteriële insufficiëntie onderste ledematen .............................................................................. 18
Anamnese................................................................................................................................................. 18
Klinisch onderzoek ................................................................................................................................... 20
Acute ischemie ............................................................................................................................................. 22
Chronische arteriële insufficiëntie van de viscera ........................................................................................ 23
Arteriële insufficientie van de extracraniële vaten....................................................................................... 24
Atherosclerose van de halsslagaders ....................................................................................................... 24
Symptomen .............................................................................................................................................. 24
Aneurysmatisch lijden .................................................................................................................................. 24
Symptomen .............................................................................................................................................. 24
Klinisch onderzoek ................................................................................................................................... 25
Beeldvorming ........................................................................................................................................... 25
H1b: Functionele semeiologie: niet-invasief vasculair onderzoek ..................................................................... 26
Onderzoeken bij perifeer arterieel lijden ..................................................................................................... 26
Enkel Arm Index (EAI) ............................................................................................................................... 26
Doppleronderzoek.................................................................................................................................... 27
Duplex echografie .................................................................................................................................... 28
tcpO2......................................................................................................................................................... 28
CT-angio ................................................................................................................................................... 28
MR-angio .................................................................................................................................................. 28
Intra-arteriele katheterangiografie .......................................................................................................... 28
Key points ..................................................................................................................................................... 29
Veneus vaatlijden ......................................................................................................................................... 29
Extracraniele vaatpathologie ........................................................................................................................ 29
Aandoeningen van de microcirculatie .......................................................................................................... 30

2. Semeiologie hart ....................................................................................................................................... 31
H2a: anamnese in de cardiologie ...................................................................................................................... 31
Thoracale pijn ............................................................................................................................................... 31
Kortademigheid ............................................................................................................................................ 32
Hartkloppingen ............................................................................................................................................. 33
Syncope ........................................................................................................................................................ 35



1

, H2b: semeiologie hart ....................................................................................................................................... 36
H2c: Hartauscultatie en hemodynamica ........................................................................................................... 37
De stethoscoop ............................................................................................................................................. 37
Auscultatiezones........................................................................................................................................... 37
4 tonen ......................................................................................................................................................... 37
Clicks ............................................................................................................................................................. 38
Geruisen ....................................................................................................................................................... 38
Specifieke afwijkingen .................................................................................................................................. 39

3. CV risico en preventie ............................................................................................................................... 40
Belang van CV risico? .................................................................................................................................... 40
Proces van atherosclerose ............................................................................................................................ 40
Modifieerbare risicofactoren !! .................................................................................................................... 40
Risico op hart- en vaatziekten berekenen -> practicum ............................................................................... 40
Risico op hart- en vaatziekten behandelen .................................................................................................. 41
Levenstijl .................................................................................................................................................. 41
Medicatie ................................................................................................................................................. 41

4. Stollingsstoornissen .................................................................................................................................. 43
4a: Stolling ........................................................................................................................................................ 43
Bloedstolling (hemostase) ............................................................................................................................ 43
Bloedingstijd ............................................................................................................................................. 43
Stollingscascade ....................................................................................................................................... 43
Onderzoek van de bloedstolling ................................................................................................................... 45
Antitrombotica ............................................................................................................................................. 45
Antiaggregantia ........................................................................................................................................ 46
Anticoagulantia ........................................................................................................................................ 46
Fibrinolytica .............................................................................................................................................. 49
Arteriele vs veneuze trombose ..................................................................................................................... 49
4b: Erfelijke en verworven bloedingsneiging..................................................................................................... 50
Oorzaken van verhoogde bloedingsneiging ................................................................................................. 50
Pathologisch bloeden: niet zo eenvoudig ..................................................................................................... 50
Tekens van verhoogde bloedingsneiging...................................................................................................... 50
Anamnese ..................................................................................................................................................... 50
Aangeboren bloedingsziekten ...................................................................................................................... 51
Hemofilie A en hemofilie B....................................................................................................................... 52
Ziekte van Von Willebrand ....................................................................................................................... 53
Verworven bloedingsneiging ........................................................................................................................ 53
Verminderde aanmaak ............................................................................................................................. 53
Productie van abnormale stollingsfactoren ............................................................................................. 53
Auto-antistoffen van stollingsfactoren .................................................................................................... 54
Verhoogd verbruik: diffuse intravasculaire coagulatie (DIC/DIS) ............................................................. 54
4b: Veneuze trombo-embolie: DVT en longembolie .......................................................................................... 56
Risicofactoren ............................................................................................................................................... 56
Verworven risicofactoren ......................................................................................................................... 56
Erfelijke risicofactoren ............................................................................................................................. 57
Wanneer denken aan (erfelijke) trombofilie? .......................................................................................... 57
Diep veneuze trombose................................................................................................................................ 57
Lokalisatie veneuze trombose .................................................................................................................. 58
Symptomen .............................................................................................................................................. 58
Diagnose ................................................................................................................................................... 58
Behandeling.............................................................................................................................................. 59



2

, Longembolie ................................................................................................................................................. 59
Locatie ...................................................................................................................................................... 59
Symptomen .............................................................................................................................................. 59
Beeldvorming ........................................................................................................................................... 59
Behandeling VTE....................................................................................................................................... 60

5. CV beeldvorming en labotesten ................................................................................................................ 62
CV beeldvorming (bloedvatenradiologie).......................................................................................................... 62
Inleiding ........................................................................................................................................................ 62
Katheter angiografie ..................................................................................................................................... 62
RX arteriografie ........................................................................................................................................ 62
RX flebografie ........................................................................................................................................... 62
Computer tomografie (CT)............................................................................................................................ 63
MRI ............................................................................................................................................................... 63
Voorbeelden ................................................................................................................................................. 63
Echocardiografie ............................................................................................................................................... 66
Technische werking ...................................................................................................................................... 66
Morfologie, globale en regionale functie ..................................................................................................... 68
Hemodynamica ............................................................................................................................................. 70
Speciale technieken ...................................................................................................................................... 71
CV Labotesten ................................................................................................................................................... 72
Biomerkers voor acuut myocardinfarct ........................................................................................................ 72
Myoglobine .............................................................................................................................................. 72
Creatinine kinase ...................................................................................................................................... 73
Troponine ................................................................................................................................................. 73
High sensitivity troponine............................................................................................................................. 73
Consensus critereria MI ........................................................................................................................... 73
Hogere gevoeligheid: hsTnT ..................................................................................................................... 74
Algoritme.................................................................................................................................................. 74
BNP en NT-proBNP ....................................................................................................................................... 75
Productie proBNP ..................................................................................................................................... 75
Hartfalen .................................................................................................................................................. 75
(NT-pro)BNP als biomerker ...................................................................................................................... 75
Dosage (NT-pro)BNP ................................................................................................................................ 75
Hoorcollege biomerkers ............................................................................................................................... 76
Bepaling van cholesterol voor CV risico ................................................................................................... 76

6. ECG ........................................................................................................................................................... 77
Fysiologie en technische achtergrond van het ECG ........................................................................................... 77
Van AP tot ECG ............................................................................................................................................. 77
Afleidingen.................................................................................................................................................... 77
Afleidingen in frontaal vlak ...................................................................................................................... 78
Afleidingen in precordiale vlak ................................................................................................................. 78
Prinipes van EKG ook gebruikt bij ................................................................................................................. 78
EKG terminologie en registratie ........................................................................................................................ 78
Terminologie................................................................................................................................................. 78
Elektriciteit vs contractie .............................................................................................................................. 79
Topografische anatomie ............................................................................................................................... 79
Registratie..................................................................................................................................................... 80
Nut van het ECG............................................................................................................................................ 80
Indicaties ECG ............................................................................................................................................... 80
ECG protocol ................................................................................................................................................. 81



3

, Normaal ECG, hypertrofie en geleidingsstoornissen (les 1) .............................................................................. 82
Normaal ECG................................................................................................................................................. 82
1. Ritme .................................................................................................................................................... 82
2. Frequentie ............................................................................................................................................ 82
3. QRS as................................................................................................................................................... 82
4. Morfologie van QRS complex ............................................................................................................... 83
5. Morfologie van het ST segment ........................................................................................................... 83
6. Morfologie van de T-golf ...................................................................................................................... 83
Hypertrofie ................................................................................................................................................... 84
Linkervoorkamerhypertrofie .................................................................................................................... 84
Rechtervoorkamerhypertrofie ................................................................................................................. 85
Linkerventrikelhypertrofie ....................................................................................................................... 85
Rechter ventrikel hypertrofie ................................................................................................................... 86
Biventriculaire hypertrofie ....................................................................................................................... 87
Geleidingsstoornissen................................................................................................................................... 87
Linkerbundeltakblok................................................................................................................................. 88
Rechterbundeltakblok .............................................................................................................................. 88
Linker anterior hemoblok ......................................................................................................................... 89
Linker posterior hemiblok ........................................................................................................................ 89
Gevorderde geleidingsstoornissen ........................................................................................................... 89
Bradycardie ................................................................................................................................................... 90
Sinusknoop gerelateerd ........................................................................................................................... 90
AV block ........................................................................................................................................................ 91
Vroegere indeling ..................................................................................................................................... 91
Nu: plaats van blok ................................................................................................................................... 92
behandeling.............................................................................................................................................. 92
Ischemie (les 2) .................................................................................................................................................. 94
Subendocardiale vs transmurale ischemie ................................................................................................... 94
ST elevatie (STEMI) ....................................................................................................................................... 95
ST depressie (NSTEMI) .................................................................................................................................. 99
T-top afwijkingen ........................................................................................................................................ 101
Q-golf .......................................................................................................................................................... 101
R-golf .......................................................................................................................................................... 101
Brugada syndroom ..................................................................................................................................... 102
Hoog risico patronen .................................................................................................................................. 102
Proximale LAD stenose ........................................................................................................................... 102
Hoofdstamletsel ..................................................................................................................................... 103
Ritmestoornissen (les 2, 3 en 4) ...................................................................................................................... 104
Antiaritmica ................................................................................................................................................ 104
4 klassen volgens Vaughan-Williams ...................................................................................................... 104
De belangrijkste antiaritmica ................................................................................................................. 104
Anamnese ................................................................................................................................................... 107
Specifieke ritmestoornissen ....................................................................................................................... 107
Atriale extrasystole ................................................................................................................................ 108
Ventriculaire extrasystole ...................................................................................................................... 109
Voorkamerfibrillatie ............................................................................................................................... 110
Voorkamerflutter ................................................................................................................................... 116
Sinustachycardie .................................................................................................................................... 118
Ectopische atriale tachycardie ............................................................................................................... 118
Junctionele tachycardie.......................................................................................................................... 119
AV nodale re-entry bradycardie (AVNRT)............................................................................................... 119
Atrioventriculaire reentrytachycardie .................................................................................................... 120
Ventrikel tachycardie ............................................................................................................................. 121



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