Dutch -ErasmusMC - week 4.4.1- HC4
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| Meest/minst voorkomende oorzaak v POB polikliniek vs. SEH | Polikliniek: Muscoskeletaal & Acuut coronair syndroom, SEH: stabiele Angina pectoris & Gastro-intestinaal
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| DD bij POB | -Aspecifiek (skeletaal, syndr v Tietze) -Angina Pectoris -Dissectie aorta thoracalis -Longembolie -Pneumothorax -Pericarditis/ pleuritis/ pneumonie -Oesophagus reflux/ spasme/ gastritis
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| Wat weten we van jongere mensen en POB | Jongere mensen hebben 'n kleinere kans op coronaire hart ziekte bij de diverse presentaties
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| leg 't coronair atherosclerose schema v klootwijk uit | plaque --> vernauwing --> stabiele AP |-> opp beschadiging (ruptuur) |--> stolselvorming (trombus) --> Instabiel AP |--> afsluiting --> necrose -myocard infarct
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| Wat is belangrijk bij verdenking v ACS ? | Snelle triage en behandeling
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| Diagnostiek bij verdenking ACS | -ECG -X-thorax -Biochemische markers (troponine) -CT-scan (aorta dissectie)
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| Behandeling v ventriculaire tachycardie | Medicamenteuze-i.v. anti-aritmica: *lidocaine *amiodarone - Electr. cardioversie
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| 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
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| ACS en ECG | - ST-elevatie (slechte afloop) - Non-ST elevatie (kleiner risico op slecht afloop)
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| Behandeling ST-elevatie ACS | ZSM reperfusietherapie - trombolyse; >50% ST-herstel binnen 60 min; persisterende ST elevatie
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| Behandeling NON-ST elevatie ACS | ZSM reperfusietherapie; afkoelen; heparine en antiplatelets; <24- 48 uur PCI
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| "definieer" 'n STEMI | -persisterende ST-elevatie op ECG -Verhoogde biochemische markers (Tn-T/I)
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| "definieer" 'n Non-STEMI | -ST-depressie of normaal ECG -Verhoogde biochemische markers (TnT/I)
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| "definieer" Instabiele Angina | -ST-depressie of normaal ECG -Normale of afw. biochem. markers
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| Wat is de nabehandeling na PCI | - Heparine - Aspirine - IIB/ IIIA bloedplaatjes - Secundaire preventie: *Beta-blokker *ACE-remmer *Statine
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| In hoe vaak v/d gevallen levert ECG de diagnose ACS ? | 40-60% v/d gevallen
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| Op 'n ECG wat is de enige uiting v/e doorgemaakt infarct ? | Q-golven
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| Welk aanvullend diagnostiek mag niet vergeten worden ? | X-thorax
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