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Samenvatting hart en vaten 1-prof. Heidbuchel-2e Bach
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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. Behaald resultaat 17/20
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HART EN VATEN 12e bachelor geneeskunde
,Inhoudsopgave
2e bachelor geneeskunde ........................................................................................................................................... 0
Inleiding cardiovasculair systeem .......................................................................................................................... 6
Schikking organen en vaatbedden:............................................................................................................................ 6
Bloedstroom doorheen het hart ................................................................................................................................ 6
Histologie van bloedvormend weefsel:.................................................................................................................. 7
Overzicht Vaten:.................................................................................................................................................... 7
Arteriën:..................................................................................................................................................................... 7
Grote elas?sche arteriën: .......................................................................................................................................... 7
Middelgrote musculaire arterie: ................................................................................................................................ 8
Arteriolen: .................................................................................................................................................................. 8
Capillairen:................................................................................................................................................................. 8
Venen: ........................................................................................................................................................................ 8
Lymfevaten: ............................................................................................................................................................... 9
Overzicht Hart: ...................................................................................................................................................... 9
Wandlagen: ............................................................................................................................................................... 9
Contrac?el apparaat: .............................................................................................................................................. 10
Hartklep: .................................................................................................................................................................. 10
Geleidingssysteem: .................................................................................................................................................. 10
Myocardinfarct: ....................................................................................................................................................... 10
Structuur en func<e cardiale myocyt ................................................................................................................... 11
Structuur: ................................................................................................................................................................. 11
Func?oneel: ............................................................................................................................................................. 11
Anatomie hart en grote vaten: ............................................................................................................................ 12
Anatomie vaten: ................................................................................................................................................. 12
............................................................................................................................................................................ 12
Onderdeel cardio-chirurgie:................................................................................................................................ 16
Onderdeel vaatziekten:....................................................................................................................................... 16
Semiologie: .............................................................................................................................................................. 16
Fysiologie:........................................................................................................................................................... 17
Plasma membraan: ................................................................................................................................................. 17
Transmembranair poten?aal: .................................................................................................................................. 18
Elektrochemische eigenschappen cel: ..................................................................................................................... 18
Ionenkanalen: .......................................................................................................................................................... 19
Types ac?epoten?alen: ............................................................................................................................................ 20
, Ritmestoornissen: .................................................................................................................................................... 20
Cardiale func<e................................................................................................................................................... 21
De Hartcyclus ...................................................................................................................................................... 21
Volumes: .................................................................................................................................................................. 21
Drukgolven: ............................................................................................................................................................. 22
Drukken: .................................................................................................................................................................. 22
Hartdebiet........................................................................................................................................................... 23
Algemene formule: .................................................................................................................................................. 23
Hartslag & hartdebiet: ............................................................................................................................................. 23
Regeling van het slagvolume: .................................................................................................................................. 23
Interac?es druk-volume curve: ................................................................................................................................ 25
HarCalen ............................................................................................................................................................ 26
Linker en rechter harWalen: ..................................................................................................................................... 26
Oorzaken harWalen: ................................................................................................................................................. 26
Compensa?e harWalen: ........................................................................................................................................... 26
Systolisch harWalen: ................................................................................................................................................. 26
Diastolisch harWalen: ............................................................................................................................................... 26
Gecombineerd harWalen: ......................................................................................................................................... 27
Compensa?emechanismen harWalen: ..................................................................................................................... 27
Pathofysiologie longstuwing: .................................................................................................................................. 28
Klinische manifesta?es: ........................................................................................................................................... 28
Diure?ca bij harWalen: ............................................................................................................................................. 28
Vasculaire func<e: .............................................................................................................................................. 29
Arterieel: ............................................................................................................................................................. 29
Arteriële bloeddruk: ................................................................................................................................................. 29
Systeemvaatweerstand: .......................................................................................................................................... 30
Regeling vaa]onus: ................................................................................................................................................. 30
Endotheel: .......................................................................................................................................................... 30
Algemeen:................................................................................................................................................................ 30
Structuur endotheel: ................................................................................................................................................ 31
Endotheel-disfunc?e: ............................................................................................................................................... 32
Veneuze funcGe: ................................................................................................................................................. 32
Veneuze druk: .......................................................................................................................................................... 32
Valsalva manoeuver: ............................................................................................................................................... 33
Belangrijkste receptoren voor BD-controle op korte termijn: .................................................................................. 33
Veneuze terugkeer en hartdebiet:............................................................................................................................ 34
, Vasculaire func?ecurve:........................................................................................................................................... 34
........................................................................................................................................................................... 34
Interac?e vasculaire en cardiale func?e curve: ....................................................................................................... 35
Inspanning: interac?es curves ................................................................................................................................. 35
Chronisch harWalen: interac?es curves.................................................................................................................... 35
Me?ng van de CVD: ................................................................................................................................................. 36
Neurohumorale controle hart en circula<e: ........................................................................................................ 36
Controle via autonoom zenuwstelsel.................................................................................................................. 36
Autonoom zenuwstelsel: .......................................................................................................................................... 36
Adrenerge en muscarine receptoren in het hart en bloedvaten: ............................................................................. 37
Ligging van de arteriële baroreceptoren: ................................................................................................................ 38
Belangrijkste reflexen: ........................................................................................................................................ 38
Brainbridge reflex: ................................................................................................................................................... 38
Chemoreceptoren: ................................................................................................................................................... 38
CNS: ischemic respons ............................................................................................................................................. 38
Cushing reflex: ......................................................................................................................................................... 39
Pijnreflexen: ............................................................................................................................................................. 39
Bezold-jarisch reflex: ................................................................................................................................................ 39
Stretch receptoren: .................................................................................................................................................. 39
Duik reflex: ............................................................................................................................................................... 39
Humorale controle: ............................................................................................................................................. 40
Effect catecholamines: ............................................................................................................................................. 40
Syncope: ............................................................................................................................................................. 42
Vasovagale syncope:................................................................................................................................................ 42
Head up ?l?ng test: ................................................................................................................................................. 43
Vasovagale syncope:................................................................................................................................................ 44
Syncope tgv orthosta?sche hypotensie: .................................................................................................................. 44
Cardiovasculaire aanpassingen bij inspanning: .................................................................................................... 44
Aanpassingen: ......................................................................................................................................................... 44
Orgaandoorbloeding bij inspanning: ....................................................................................................................... 45
Mechanismen bij inspanning: .................................................................................................................................. 45
Veranderingen hemodynamica: .............................................................................................................................. 45
Factoren met invloeden op de CV aanpassingen: .................................................................................................... 45
Orgaanperfusie: .................................................................................................................................................. 46
DistribuGe van het hartdebiet per orgaan: ......................................................................................................... 46
, Bepaald door: .......................................................................................................................................................... 46
Autoregula?e ........................................................................................................................................................... 47
Reac?eve hyperemie:............................................................................................................................................... 47
Ac?eve hyperemie: .................................................................................................................................................. 47
Coronaire circulaGe:............................................................................................................................................ 48
Belangrijkste kenmerken: ........................................................................................................................................ 48
Autoregula?e coronaire flow: .................................................................................................................................. 48
Impact stenose op coronaire flow reserve ............................................................................................................... 49
Func?onele flow reserve: ......................................................................................................................................... 49
Angina pectoris: ....................................................................................................................................................... 50
Cerebrale circulaGes: .......................................................................................................................................... 50
Cirkel van Willis: ...................................................................................................................................................... 50
Autoregula?e cerebrale flow: .................................................................................................................................. 51
SpiercirculaGe: .................................................................................................................................................... 51
Belangrijkste kenmerken: ........................................................................................................................................ 51
HuidcirculaGe: ..................................................................................................................................................... 51
Belangrijkste kenmerken: ........................................................................................................................................ 51
Splanchnische circulaGe:..................................................................................................................................... 52
Belangrijkste kenmerken: ........................................................................................................................................ 52
Lever: ....................................................................................................................................................................... 52
Milt: ......................................................................................................................................................................... 53
Renale circulaGe: ................................................................................................................................................ 53
Belangrijkste kenmerken: ........................................................................................................................................ 53
............................................................................................................................................................................ 54
LongcirculaGe:..................................................................................................................................................... 54
Belangrijkste kenmerken: ........................................................................................................................................ 54
Pulmonale hypertensie: ........................................................................................................................................... 54
Microcircula<e: ................................................................................................................................................... 55
Func?es:................................................................................................................................................................... 55
Doorbloeding capillair: ............................................................................................................................................ 55
Transport doorheen de capillaire wand: .................................................................................................................. 55
Diffusie: Wet van Fick .............................................................................................................................................. 55
Hb-O2 dissocia?ecurve: ........................................................................................................................................... 56
Co2 uitwisseling: ...................................................................................................................................................... 56
Transcapillaire vochtuitwisseling: ............................................................................................................................ 56
Pathofysiologie oedeem: ......................................................................................................................................... 57
Lymfevaten: ............................................................................................................................................................. 58
Hypotensie: ........................................................................................................................................................ 59
, Defini?e: .................................................................................................................................................................. 59
Oorzaken:................................................................................................................................................................. 59
Compensatoire mechanismen: ................................................................................................................................ 59
Compensa?e naar decompensa?e: ......................................................................................................................... 60
Therapie:.................................................................................................................................................................. 60
Cardiovasculaire aanpassingen <jdens zwangerschap: ........................................................................................ 61
Normale cardiovasculaire veranderingen:............................................................................................................... 61
Inspec?e normale cardiale bevindingen: ................................................................................................................. 62
Klachten ?jdens de zwangerschap: ......................................................................................................................... 62
Pathologie ?jdens zwangerschap: ........................................................................................................................... 62
ACLS: advanced cardiac life support .................................................................................................................... 63
Indeling: ................................................................................................................................................................... 63
Basisprincipes cardioversie en defibrilla?e: ............................................................................................................. 63
Klinisch onderzoek: harRonen en hartgeruis ....................................................................................................... 64
Medische fysica circula<e: druk, flow & weerstand ............................................................................................. 65
Wet van Ohm: voor vloeistoffen .............................................................................................................................. 65
Haemodynamica: .................................................................................................................................................... 65
Weerstand: .............................................................................................................................................................. 65
Viscositeit: ............................................................................................................................................................... 66
Ideaal versus realiteit: ............................................................................................................................................. 66
Laminaire- en turbulente stroming: ......................................................................................................................... 67
Druk in circula?e:..................................................................................................................................................... 67
Onderzoeksmethoden bloedvaten: ..................................................................................................................... 68
Veneuze pathologie: (thorax en vaatheelkunde) ................................................................................................. 68
Veneuze pathologie: ................................................................................................................................................ 68
Varices: spataderen ................................................................................................................................................. 68
Anamnese: ............................................................................................................................................................... 69
Behandeling: ............................................................................................................................................................ 70
Congenitale vasculaire malforma?es en hemangiomen: ........................................................................................ 71
Pathologie van de lymfecircula<e:....................................................................................................................... 73
Anatomie: ................................................................................................................................................................ 73
Func?es van het lymfa?sch systeem: ...................................................................................................................... 73
Pathologie lymfoedeem: .......................................................................................................................................... 74
,Inleiding cardiovasculair systeem
Schikking organen en vaatbedden:
• Pulmonale en systeem-circula1e in serie
(Maw pompen eenzelfde debiet, wat binnenkomt wordt terug uitgepompt)
• Circula1e orgaansystemen gebeurt in parallel
- Lever staat in serie met gastro-intes1nale tractus
- Auto-regula1e
• Verband druk, debiet, vaatweerstand: F=P/R
- Weerstanden in parallel: 1/R1+2/R2+…
- Weerstanden in serie: R1+R2+…
Bloedstroom doorheen het hart
• Rechterhart: SVC+IVC→RA→RV→PA
• Linkerhart: PV→LA→LV→aorta
• Watertoren model: overloopsysteem met kraantjes
• Distribu1e van het bloedvolume:
- 70% veneus volume
- 15% hart en longen
- 10% arterieel
- 5% capillairen/haarvaatjes
• Vasculaire systeem:
- Dient als reservoir
- Regelt bloeddruk
- Uitwisseling met de weefsels
- VrijzeXng vasoac1eve stoffen (vaaZonus, hemostasis, inflammatoir)
,Histologie van bloedvormend weefsel:
Overzicht Vaten:
• Arteria
- Grote elas1sche arterie (aorta en grote a]akkingen)
- Musculaire arterie (distribu1evaten)
• Arteriole (weerstandsvaten)
• Capillairen
- Con1nu, gefenestreerd of discon1nu
• Venen:
- Post-capillaire venulen
- Musculaire venulen
• Lymfevaten:
- Lymfa1sche capillairen
- Grotere lymfevaten
Arteriën:
• Wandlagen:
- Tunica in1ma:
§ Endotheel
§ Subendotheliale laag
• Membrana elas1ca interna
• Tunica media
- Glad spierweefsel
- Collagene vezels (venen >arteria)
- Elas1sche vezels
• Membrana elas1ca externa
• Tunica adven11a
- Vasa vasorum (grote vaten)
- Bindweefsel
Opm.: alle vaten met membrana elas1ca interna zijn arteria, buiten in de navel.
Grote elas;sche arteriën:
• Aorta en grote a]akkingen
• Specifieke kenmerken:
- Hoog debiet en druk
- Onderhouden van constante bloedstroom (diastole)
• Tunica media: elas1sche vezels
- Aangemaakt door gladde spiercellen
,Middelgrote musculaire arterie:
• Distribu1evaten
• Tunica media:
- Glad spierweefsel overwegend
- Minder elas1sche vezels
Arteriolen:
• Weerstandsvaten
• Reguleren bloedstroom en weerstand
• Tunica media: 2-5 cellagen
• Metarteriole: terminale vertakking, 1 cellaag gladde spiercellen
Capillairen:
• Bestaat uit endotheel omgeven door basaalmembraan
1. Con1nu capillair:
- Con1nu basaal membraan
- Pericyten (gladde spiercel)
- Verbinding door 1ght junc1ons en transport door transcytose (caveolae)
§ Voorbeeld: alveolaire wanden
2. Gefenestreerd capillair:
- Fenestrae met of zonder diafragma
§ Voorbeeld mét: darmwand
§ Voorbeeld zonder: nier glomeruli
3. Discon1nu capillair (=sinusoïden):
- Onderbrekingen in het capillair groot
- Discon1nu basaal membraan
Venen:
• Wandlagen:
- Géén m. elas1ca interna
- Tunica media: meer collagene vezels
- Tunica muscularis dunner
- Kleppen
, 1. Post-capillaire venulen:
- Diapedese (d.m.v. selec1nes en integrines)
- Hoog-endotheliale venulen in lymfoide organen
2. Musculaire venulen
Lymfevaten:
1. Lymfa1sche capillairen:
- Endotheel
- Geen volledig basaal membraan
- Aanwezig in alle weefsels, behalve: kraakbeen, bot, epitheel, CZS, beenmerg
2. Grotere lymfevaten: (cfr venen)
- Tunica in1ma
- Tunica media
- Tunica adven11a
- Met kleppen en lymfeklieren
Overzicht Hart:
Wandlagen:
• Hartskelet:
- Dicht collageen bindweefsel
- Scheiding atria/ventrikels
- Aanhech1ng kleppen
- Annuli fibrosi, trigona fibrosa, septum membranaceum
• Endocard:
- Rond de atria, ventrikels en kleppen
- Binnenste laag: endotheel en subendotheliaal bindweefsel
- Middelste laag: gladde spiervezels en elas1sche
- Buitenste laag: bindweefsel, bloedvaten en adipocyten
• Myocard:
- Rond het hartspierweefsel
- Ertussen het endomysium: bindweefsel met capillairen
- Niet gefuseerde cellen en veel mitochondria
- Intercalaire schijven (gap junc1ons, 1ght junc1ons en desmosomen)
- Gespecialiseerde cardiocyten
§ Myo-endocriene cardiocyten (produc1e ANF)
§ Nodale cardiocyten
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