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Congestief hartfalen

CONGESTIEF HARTFALEN

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1. Oorzaken

- verminderde contractiliteit van het myocard
- cardiale oorzaken: ischaemie (AMI), cardiomyopathie, myocarditis
- niet cardiale oorzaken: medicatie, metabole stoornissen
- overload:
- hypertensie
- klepafwijkingen
- congenitale hartafwijkingen
- overvulling
- thyrotoxicose
- ernstige anaemie

 

2. Diagnostiek

- kliniek
- acuut hartfalen
- cardiogene shock:
- pulmonaal: tachypnee, cyanose, longoedeem, cheyne- stokes ademhaling, sputum
- cardiaal: gecombineerd met myocardischaemie of AMI, tachycardie, milde hypotensie, pulsus alternans
- bewustzijn: angst, verwardheid, vermoeidheid
- chronisch hartfalen
- linker hartfalen:
- ademhaling: dyspnee, orthopnee, paroxysmale nocturale dyspnee, verminderde inspanningstolerantie
- auscultatie: reutels, wheezing, longbasis verminderde ventilatie hoorbaar, S3 gallop, soms S4
- rechter hartfalen:
- dyspnee d'effort
- beeld van overload (opzetting halsvenen, ascites, oedeem)
- hepatomegalie
- bewustzijn: vermoeidheid, zwakte
- labo
- electrolieten
- ureum/creatinine
- hartenzymen
- Rx Thorax
- cardiomegalie
- pulmonaire redistributie: interstitieel oedeem, typisch butterflyinfiltraat (=Frank alveolair infiltraat.  Soms assymetrisch en dan vaak als pneumonie gezien), verder ook effusies
- Electrocardiogram
- cardiomegalie
- echocardio
- acuut kleplijden
- pericardtamponade
- contractiliteit myocard

- vullingstoestand

 

3. DD

- Linker hartfalen
- pulmonaal:
-  acute COPD opstoot
- acute asthma-opstoot
- ARDS
- pneumonie
- bronchitis
- cardiaal:
- constrictieve pericarditis
- pericardtamponade
- rechter hartfalen
- nefrotisch syndroom

- cirrose

 

 

Eerste opvang

- IV lijn
- O2
- Monitoring
- nitraten sublinguaal
- Lasix
- patient best rechtop
- soms nood aan intubatie

 

Spoeddienst

- Is er hypotensie?
- neen: is er urgente hulp nodig?
- Ja: diuretica, nitraten, morfine
- neen: poliklinisch: ACE-inhibitoren, diuretica
- Ja: geef GEEN nitraten, morfine of diuretica!

          - geef Dopamine of Dobutamine

 

REFERENTIES:

 

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