Summary
Samenvatting overzicht van de behandelingen in cardiologie
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overzicht van de behandelingen in cardiologie
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Aandoening TherapiePreventie CV risico Beweging
Mediteraans dieet
Rookstop
Event doorgemaakt: altijd Statine ev + ezetimibe, ev bempedoinezuur, ev PCSK9-I of
hoogste risico!!! iclisiran
Antihypertensiva: ACE- I/ARB +diureticum/ca-I of +ca-I, b-
blokker, spironolactone, ander diureticum
DM: metformine, SGLT2-I, GLP1-agonist
Secundaire preventie:
aspirine + clopidrogrel 1j, erna aspirine levenslang
DOAC
ACS: NSTEMI Monitoring
- Progressie trombose voorkomen
1. EKG Aspirine + clopidrogrel (stent)/ ticagrelor (CABG)
2. Labo: troponine LMWH
3. RX - ischemie beperken
4. Echo b-blokker
5. Low risk: CT angio nitraten
6. High risk: coronaro + - plaque stabiliseren
invasieve R/ statine
ACE-I
Onstabiel < 24u stent - later PCI vs CABG
Stabiel < 3- 7 d PCI vs CABG
Trias na CABG: statine, aspirine + ticagrelor, b-blokker
NOAC voor Afib
ACS: STEMI Aspirine + clopidrogrel(stent)/ ticagrelor (CABG)
Thuissituatie: aspirine LMWH
160 mg, nitraat 5 mg, B blokker (niet indien hyperacuut, tachycardie is secundair)
morfine 5 mg! Nitraat?
morfine + anti- emeticum
CAVE VFIB 10%-> shock!!!! extra zuurstof indien lage sat
Rca -> AV blok Revascularisatie binnen 90 min (direct PCI)
Niet binnen 90 min (trombolyse en doorsturen!)
Begeleid transport! Complicaties: urgent CABG
3 takslijden: < 3- 7d CABG
Geen ACE- I en statine Trias na CABG: statine, aspirine + ticagrelor , b-blokker
NOAC voor Afib
Lange termijn na AMI Aspirine + clopidrogrel 1j
Secundaire preventie: aspirine levenslang, statine, ACE- I
ACE- I bij uitgebreid of LV dysfunctie > remoddeling
b- blokker 1j voor VT
Multidisciplinaire revalidatie
Chronisch coronair lijden Medicatie
= stabiele aangor - preventie: aspirine, statine, soms ACE-I
Low risk: cycloergo + SPECT - onderhoud b blokker (indien andere indicatie) of ca2+ antago
, High risk: CT angio en - 2e keus: ivabradine, molsedomine, langwerkend nitraat
coronaro - aanval nitraten
Geen LMWH Hoog risico, klachten blijven - > Electief PCI of CABG
Opp veneuze insufficientie Preventie: vermijd lang staan, vermijd warmte, hoogstand van
= Varices de benen, lichaamsbeweging,wisselbaden, gewicht, rookstop
D/ duplex Compressie kousen kl 1- 3
Beter bij stappen Sclerotherapie - kleinere, perforanten, recidief
Endoveneuze ablatie (90%)
Flebectomie - collateralen, perforanten
Flebotonica
<< stripping (10%) - vsm vsp trombose
Diep veneuze insufficientie Preventie
Compressie: acuut korte rek, levenslang steunkousen kl 3
Veneuze claudicatio!! Flebotonica (ulcera genezing)
Stent, bypass
Kleptranspositie, reconstructie (korte termijn > litteken)
Secundaire varices behandelen
Tromboflebitis Anti- inflammatoire zalf
Ev compressive therapie
LMWH of DOAC bij proximaal VSM of trombose > 3cm 6w-3m
Preventie DVT post-op Elastische kousen
Kine: mobilisatie
Intermittente pneumatische compressie
Clexane 20-40 mg 1x/d
Behandeling DVT Korte rek verbanden, erna steunkous II, III
Hoogstand, Bewegen
LMWH: clexane 1 mg/kg 2x 5-7d
+ na enkele dagen VKA of DOAC
Trombolyse niet post-op of Soms trombolyse > prox ilio- femorale DVT
bij bloedingsrisico Soms trombectomie > prox ilio- femorale DVT met contra- I
voor trombolyse, phlegmasia caerulea dolens
VC filter > recidief LE, post- op met contra- I voor antico, cor
pulmonale
Lymfe- oedeem Preventie infectie + hydratatie huid
2- 4w korte rek verbanden (dag en nacht)
Erna compressie sokken (dag)
Bewegen
(lymfedrainage)
Lymfeveneuze anastomose of LN transplant kan
Cave erysipelas: IV of PO flucloxacilline of claritromycine 14d
Chronische perifeer Rutherford 0: preventie
arterieel vaatlijden Rutherford 1,2,3: claudicatio
- Rookstop, dieet, beweging (looptraining)
- claudicatio - Aspirine
- critical limb - Statine
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