Summary
Samenvatting Overzichtschema's van grote hoofdstukken prof. Janssens
- Course
- Institution
Enkele schema's die overzicht geven in grote en belangrijke hoofdstukken van Janssens.
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HF Defini)e PathologischKlinisch
Types
Prevalen)e
Oorzaken Algemeen Intrinsiek
<-> uitlokkende factoren
Overbelas)ng (druk, volume , metabole nood, pericardaandoeningen)
HFrEF Intrinsiek
Overbelas)ng
Uitlokkend
HFpEF Overbelas)ng
Uitlokkend
Klinische tekens
Li falen <-> Re falen
Compensatoire Neuro- ZS OZS Hoe ac)va)e? S)m van baro-, chemo- en metaborecep
mechanismen endocrien Te meten in plasma (norepi-conc.) en klinisch (bleek/tachy/zweten)
PZS: minder ac)viteit (te zie aan HR-variabiliteit
RAAS: ac)va)e door Ang II -> vasoconstric)e
hypotensie thv renale Aldosteron -> Na+ en water-reten)e
barorecep Vasopressine Vasocon Rechtstreeks
Gepoten)eerd met NE
+
Na en water-reten)e
Complexiteit
Natriure)sch < secre)e van ventrikels die wandspanning/dilata)e ondervinden
Werking Vasodilata)e als compensa)e voor vasocon (ma zwak)
Inhibi)e door neprylisine
(Nt-pro)BNP correleert met wandspanning -> Dx en monitor op R/
Hypertrofie en remodeling Door Dilata)e van ventrikel
Verhoogde wandspanning
Verhoogde drukbelas)ng
Gevolg Guns)g: ikv adapta)e voor verlies van hartspierweefsel en
bestand zijn tegen hoge druk
, Onguns)g ≈ maladapta)e (minder capillairen, veranderingen in
myosineketens, overma5g collageen) -> sys en dia dysfunc)e
Vasoconstric)e tgv endotheeldysfunc)e (ona]. van alle andere systemen)
Energie deficit (insuline resisten)e + mitochondiale dysfunc)e in hartspiercellen)
Inflam cytokines: IL-1β and TNF-α -> rol in remodelering en endotheeldysfunc)e -> ev. target vr R/
Classifica)e NYHA
Behandeling Medicijnen Hoeksteen ACE-I/ARB/ARNI
MRA
β-blokkers “niks lol aan bisoprolol” – Kaat
SGLT2-inhibitoren
Symptoomcontrole Diure)ca
Digitalis
CCBs (NIET verapamil en dil)azem)
Acuut HF Deconges)e
Vasodilata)e
Inotropica IV
Fysieke training + monitoring thuis
Devices ICD
Resynchronisa)etherapie
Voor een falend hart IABP
ECMO
Mini-pompen
Implanteerbare lange-termijn pompen -> des)na)on therapy
Hariransplanta)e
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