Atriumfibrillatie
ATRIUMFIBRILLATIE
Mechanismen
- Chaotische atriale activiteit (350 - 600/min)
- geen goede atriale contracties
- reactie van de ventrikel : AV nodulus remt de doorgang van de impulsen af tot 160-200/min
- gevolgen
- verminderd slagvolume en cardiac output
- spontane reconversie: bij eerste keer vaak spontane reconversie binnen 24u.
- Bij 30% herneemt het sinusritme zonder medicatie.
- complicaties:
- mortaliteit verdubbelt
- CVA: bij 35% van casi. Embolen worden vaak afgeschoten bij reconversie.
Hersenbloedingen worden gezien bij anticoagulatie
- syncope
- angor
- darmischaemie
- bij therapie: digitalisintoxicatie
Risicofactoren om atriumfibrillatie te ontwikkelen
- idiopathisch
- cardiaal
- coronair vaatlijden
- hypertensie
- mitraliskleplijden
- chronische pericarditis
- Wolff-Parkinson-White syndroom (WPW)
- Longen
- longembolen
-chronisch longlijden
- Hypothyroidie
- Ethylisme
2. Kliniek
- Altijd
- onregelmatige pols
- auscultatie: onregelmatige hartslag, S1 variabele intensiteit
- Monitoring: onregelmatig; af en toe geen QRS-complex
- Stabiele patiënt
- palpitaties
- dyspnee
- zwakte
- ijl hoofd
- syncope
- Instabiele patiënt
- hypotensie
- persistente angor
- longoedeem
- BWZ-daling
3. Diagnostiek
- ECG: geen duidelijke P-toppen
- Labo: CBC, Elektrolyten, hartenzymen, schilklierfunctie
- Pulse oxymetrie
- echocardio: is er atriale uitzetting? (als oorzaak)
is er een atriale thrombus (onmiddellijke anticoagulatie)
4. DD
- atriale flutter met wisselende AV-blok
- Multifocale atriale tachycardie
- sinusritme met frequente premature atriale contracties
- atriale tachycardie
Eerste opvang
- is de patient stabiel?
- indien ja: gewoon transport naar het ziekenhuis
- indien nee: onmiddellijke reconversie en ALS
- zuurstof
- IV-lijn
- monitoring
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- Wanneer moet therapie gestart worden? vraag: is de patient stabiel?
- Welke therapie?
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- Is de patient stabiel?
- Adenosine: best alleen voor supraventriculaire. Eerst 6 mg snel IV. Zo nodig herhalen na 2 minuten (12 mg)
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