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Samenvatting Hartspier- deel 2 $3.80   Add to cart

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Samenvatting Hartspier- deel 2

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Prof Geert Callewaert

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  • August 13, 2018
  • 11
  • 2017/2018
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HF3 HARTSPIER – DEEL2
Hartfalen:
= tekort in mogelijkheid vh hart om bloed te pompen in reactie op systemische verzoeken
1. Systolische dysfunctie (inotropy)
o Verzwakte ventriculaire contractie
 Verlies v inotropy
 EF vermindert
 Ca2+ huishouding verstoord: SERCA, PLB,….
 Inotropie makkelijk te regelen:
o Hogere ORTHO
o Slagvolume stijgt CO stijgt
o Lagere PARA
o Effect op EF (ejectie fractie)
2. Diastolische dysfunctie (passieve/actieve spanningsontw)
o Ventrikelwand nt meer rekbaar
o Verzwakte ventriculaire relaxatie
 Verminderde ventriculaire vulling
 CO daalt
 EF behouden (50-60%)
 Sommige mensen kunnen zelf 1 + 2 hebben: heel weinig SV over
- OORZAKEN: Ejectiefractie (EF):
o Ischaemia = slecthe bevloeding - Normaal: 50-60%
 Verkalking/vervetting vd BV - Sport: 90%
o Lang staan hypertensie - Hartfalen: 20%
o Genetische myopathie  Is te meten
- GEVOLGEN:
 vermoeidheid
 dyspnoea = kortademig
 Oedema = opzwellen weefsels dr vochtophoping
(LV falen  longfalen  RV falen oedema in ledematen & buik)
Hartinfarct:
- OORZAKEN:
o Stukje LV kwijt:
 Extra mech ingezet om op te lossen
 Hartspier hermoduleert zich
 Werkt minder & minder goed
 Chronische hartalen  dood
 Ejectiefractie
EF = (SV / EDV) x 100 SV = EDV - ESV
- Normaal: 50-60%
- Sport:
o verhoogd SV (dr verhoogde inotropie)  EF = 90%
- Systolische hartfalen:
o EDV stijgt  SV daalt  EF = 20% of minder
- Diastolische hartfalen:
o Hypertrofsche vulling dr lage ventriculaire compliantie
 SV verlaagt SDV verlaagt  EF verandert niet

,  MI & LV hartfalen
Hartinfact in LV
(LV de belangrijkste)
- Hermoduleren: lang proces
- PV-lus:
o Blauw: normaal
o Rood: hartinfact
 SV daalt BP daalt
 Wil je compenseren:
o SNS (ORTHO)
o RAAS:
 thv de nier
 rol bij regelen v BP




 RAAS
Hartinfact:
- Hypofusie vd nier (= trigger) = minder bevloeiding
o GEVOLG:
1. Renine vrijzetten:
o Enzyme dat angiotensine  angiotensine 1
2. ACE
o Enzyme dat angiotensine 1  angiotensine 2
o Angiotensine 2:
1. Na zouten + H2O behouden in licSV hohaam
 Minder H2O secretie
 Bloedvolume hoger preload hoger SV hoger
2. Aldosterone secretie door nier
 Stimuleert (1)
3. ORTHO verder gestimuleerd
4. Arteriolaire vasoconstrictie
 BP stijgt perfusie vd nier w hersteldt


Hermodulering hart over LT  hartspier funct niet meer?  hart faalt

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