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POB & onregelm. pols

Dutch -ErasmusMC - week 4.4.1- HC4

QuestionAnswer
Meest/minst voorkomende oorzaak v POB polikliniek vs. SEH Polikliniek: Muscoskeletaal & Acuut coronair syndroom, SEH: stabiele Angina pectoris & Gastro-intestinaal
DD bij POB -Aspecifiek (skeletaal, syndr v Tietze) -Angina Pectoris -Dissectie aorta thoracalis -Longembolie -Pneumothorax -Pericarditis/ pleuritis/ pneumonie -Oesophagus reflux/ spasme/ gastritis
Wat weten we van jongere mensen en POB Jongere mensen hebben 'n kleinere kans op coronaire hart ziekte bij de diverse presentaties
leg 't coronair atherosclerose schema v klootwijk uit plaque --> vernauwing --> stabiele AP |-> opp beschadiging (ruptuur) |--> stolselvorming (trombus) --> Instabiel AP |--> afsluiting --> necrose -myocard infarct
Wat is belangrijk bij verdenking v ACS ? Snelle triage en behandeling
Diagnostiek bij verdenking ACS -ECG -X-thorax -Biochemische markers (troponine) -CT-scan (aorta dissectie)
Behandeling v ventriculaire tachycardie Medicamenteuze-i.v. anti-aritmica: *lidocaine *amiodarone - Electr. cardioversie
relatie canonwaves en hoge CVD ? Bij obstructie v tricuspidalisklep, bij VT, kan 't bloed niet naar 't rechter ventrikel stromen en daardoor zie je dit als pulsaties in de hals
ACS en ECG - ST-elevatie (slechte afloop) - Non-ST elevatie (kleiner risico op slecht afloop)
Behandeling ST-elevatie ACS ZSM reperfusietherapie - trombolyse; >50% ST-herstel binnen 60 min; persisterende ST elevatie
Behandeling NON-ST elevatie ACS ZSM reperfusietherapie; afkoelen; heparine en antiplatelets; <24- 48 uur PCI
"definieer" 'n STEMI -persisterende ST-elevatie op ECG -Verhoogde biochemische markers (Tn-T/I)
"definieer" 'n Non-STEMI -ST-depressie of normaal ECG -Verhoogde biochemische markers (TnT/I)
"definieer" Instabiele Angina -ST-depressie of normaal ECG -Normale of afw. biochem. markers
Wat is de nabehandeling na PCI - Heparine - Aspirine - IIB/ IIIA bloedplaatjes - Secundaire preventie: *Beta-blokker *ACE-remmer *Statine
In hoe vaak v/d gevallen levert ECG de diagnose ACS ? 40-60% v/d gevallen
Op 'n ECG wat is de enige uiting v/e doorgemaakt infarct ? Q-golven
Welk aanvullend diagnostiek mag niet vergeten worden ? X-thorax
Created by: SavageMD
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