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2016 | OriginalPaper | Hoofdstuk

24. Hartkloppingen

Auteurs : H. C. P. M. van Weert, R. J. G. Peters

Gepubliceerd in: Diagnostiek van alledaagse klachten

Uitgeverij: Bohn Stafleu van Loghum

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Samenvatting

Hartkloppingen komen vaak voor, maar lang niet iedereen gaat ervoor naar de dokter. Veel mensen beschouwen het (af en toe) waarnemen van de hartslag als normaal. Er is geen duidelijke relatie tussen het ervaren van hartkloppingen en het bestaan van een objectieve ritmestoornis. Bij bijna de helft van de spreekuurbezoekers bestaat er geen aandoening van het hart, maar is een psychische of psychiatrische diagnose de verklaring voor hun klachten. Deze diagnose dient op positieve gronden te worden gesteld. Ongeveer 30 % van de patiënten met een aritmie heeft tevens last van paniekaanvallen of depressie. Beide aandoeningen komen vaak samen voor. Behalve somatische diagnostiek dient bij iedere patiënt ook aandacht te worden gegeven aan de belevingsaspecten van de klacht. Met behulp van anamnese en lichamelijk onderzoek kunnen boezemfibrilleren en extrasystolie met grote waarschijnlijkheid worden vastgesteld. Een ECG-registratie tijdens een aanval is echter noodzakelijk om tot een definitieve diagnose te komen, in het bijzonder bij aanvalsgewijze klachten. Daarvoor zijn effectieve ambulante methoden beschikbaar. Als het om ritme- of geleidingsstoornissen gaat, komen supraventriculaire tachycardieën het meest voor. Al of niet aanvalsgewijs boezemfibrilleren is daarvan klinisch de belangrijkste. Ventriculaire ritmestoornissen komen voornamelijk voor bij structurele hartziekte. Begeleidende klachten kunnen wijzen op klinisch relevante ritmestoornissen. Ongeveer 10 % van de patiënten heeft een extracardiale aandoening, waarbij met name anemie, de schildklier en bijwerkingen van medicatie van belang zijn.
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Metagegevens
Titel
Hartkloppingen
Auteurs
H. C. P. M. van Weert
R. J. G. Peters
Copyright
2016
Uitgeverij
Bohn Stafleu van Loghum
DOI
https://doi.org/10.1007/978-90-368-1274-0_24

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