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Samenvatting Cardiologie en thoraxchirurgie
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  • Course
  • Intensive Care Verpleegkundige
  • Institution
  • Intensive Care Verpleegkundige
  • Book
  • Leerboek intensive-care-verpleegkunde 2

Duidelijke samenvatting over cardiologie en thoraxchirurgie

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  • No
  • Unknown
  • November 26, 2021
  • 30
  • 2020/2021
  • Summary

Subjects

  • cardiochirugie
  • acls
  • eerste hart hulp
  • ecg
  • vaatchirugie
  • thoracale pijnklachten
  • longembolie
  • complexe cardioligshce patient
  • mechanical circulatory support

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  • Intensive Care Verpleegkundige
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Module cardiologie en thoraxchirurgie

Inhoudsopgave
Module cardiologie en thoraxchirurgie.......................................................................................................... 1
Cardiochirurgie.....................................................................................................................................................2
Verschillende cardio chirurgische ingrepen....................................................................................................2
Minimaal invasieve metingen en Swan Ganz catheter...................................................................................7
ACLS.....................................................................................................................................................................9
Training ACLS...................................................................................................................................................9
De complexe cardiologische patiënt..................................................................................................................10
De complexe cardiologische patiënt.............................................................................................................10
De complexe cardiologische patiënt – medisch............................................................................................15
Externe pacemaker........................................................................................................................................17
Eerste hart hulp..................................................................................................................................................18
EHH................................................................................................................................................................18
Verdieping in het ECG.........................................................................................................................................19
ECG.................................................................................................................................................................19
Mechanical circulatory support (MCS)...............................................................................................................21
MCS................................................................................................................................................................21
Vaatchirurgie......................................................................................................................................................21
Aortadissectie en TAA....................................................................................................................................21
Thoracale pijnklachten.......................................................................................................................................27
Longembolieën..............................................................................................................................................27

Module cardiologie en thoraxchirurgie.......................................................................................................... 1
Cardiochirurgie.....................................................................................................................................................2
Verschillende cardio chirurgische ingrepen....................................................................................................2
Minimaal invasieve metingen en Swan Ganz catheter...................................................................................7
ACLS......................................................................................................................................................................9
Training ACLS...................................................................................................................................................9
De complexe cardiologische patiënt..................................................................................................................10
De complexe cardiologische patiënt.............................................................................................................10
De complexe cardiologische patiënt – medisch............................................................................................15
Externe pacemaker........................................................................................................................................17
Eerste hart hulp..................................................................................................................................................18
EHH................................................................................................................................................................18
Verdieping in het ECG........................................................................................................................................18
ECG................................................................................................................................................................18
Mechanical circulatory support (MCS)...............................................................................................................20
MCS................................................................................................................................................................20
Vaatchirurgie.....................................................................................................................................................21
Aortadissectie en TAA...................................................................................................................................21
Thoracale pijnklachten.......................................................................................................................................25
Longembolieën..............................................................................................................................................25


1

, Cardiochirurgie
Verschillende cardio chirurgische ingrepen

Hoofdstuk 2 en hoofdstuk 3 intensive care verpleegkunde deel 1:

CABG: coronair artery bypass grafting
Een directe re-vascularisatie waarbij een anastomose van de vernauwde of afgesloten kransslagaders
gemaakt wordt, voorbij de stenose. Bypass kan met venus of arterieel vat worden gemaakt.
Operatie Parameters Complicaties Medicatie
Indicatie: hoofdstamstenose, 3-taks IC en MC-  Cardiaal:  Nor, dobu, milirinone
coronarialijden, proximale LAD met ½ patiënt myocardschade/infarct Antistolling:
taks lijden, 2 taks lijden met EF<50%. monitoring  AF  Aspegic, ascal
½ takslijden met groot gebied  Bloeding/graft falen (troboseprofylaxe)
viabiliteit. Medicatie refractair  CNS (neurologisch  Indien STEMI/NSTEMI
(ineffectief)  Pneumonie <1 jaar gleden: een
 Nierinsufficiëntie jaar ticagrelor
 Ader uit onderbeen/dij of arm of  Mediastinitis  Spasmepreventie bij
arteria mammaria arteriële grafts:
 Vrij transplantaat (graft nicardipinepomp tot
ingeplant tussen aorta axendens dag 1
en kransslagader, distaal van de  Bij radialis: nitro ipv
vernauwing) nicardipine, daarna
amlodipine

Kleppen:
Aorta
Arotaklepstenose:
- Oorzaken
o Aangeboren,
o Voorafgaand acuut reuma,

2

, o Degeneratieve vorm + secundaire verkalking
- Verschijnselen
o Hypertrofie linker ventrikel
o Toegenomen hartfrequentie
o Angina pectoris
o Dyspneu, moeheid, duizeligheid en collaps
o Zuurstofbehoefte gestegen
o Ernstig: eindiastolische druk neemt toe,
Diastolische druk in aorta af -> perfusiedruk in coronair systeem af
- Diagnostiek
o Auscultatie: luide, ruwe, voeg/mid systolische souffle
o ECG: Diepere S in afl. v1 en v2, hogere R in afl. v5, v6,1 en aVL, negatieve t toppen,
ST-segment afwijkingen. (Linkerventrikelhypertrofie)
o Echodoppleronderzoek
 Doppler: maximale snelheid van bloedstroom in aorta gemeten
o Coronair angiografie
- Behandeling
o Klep vervangen bij klachten
 Homograft, bio prothese, mechanische klep


Aortaklep-insufficiëntie:
- Oorzaken
o Acuut reuma
o Voorafgaande endocarditis
o Aangeboren
o Syndroom van Marfan
 Lichaam maakt bindweefsel niet goed aan
o Dissectie (scheuring) van de aorta als gevolg van atherosclerose
o Lues/ syfilis
- Verschijnselen
o Tijdens diastole bloed van aorta terug in linkerventrikel
o Daalt bloeddruk in aorta
o Diastolische druk stijgt in linkerventrikel
o Vroege fase van diastole lekkage het grootst
- Diagnostiek
o Auscultatie: vroeg diastolisch, hoogfrequent geruis
o Verschil systolische en diastolische bloeddruk groter
o ECG: beeld linkerventrikel hypertrofie
o Decompensatio cordis
o Kortademigheid, angina pectoris en moeheid
o Vermindering perfusiedruk in coronair systeem
o Echodoppleronderzoek
- Behandeling
o Operatie
 Eindsystolische dimensie in paraternale lange as opname boven 5cm
o Medicatie voor afterloadverlaging
 ACE-remmers, diuretica, digitalis

AVR: aortic valve replacement

3

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