2024-
2025
ECG
PROF DR WILLEMS
JOZEFIEN CEULEMANS
,ECG zelfstudie ............................................................................................................................ 5
Hoofdstuk 1: fysiologie en technische achtergrond .............................................................. 5
Actiepotentialen ................................................................................................................. 5
Vector ................................................................................................................................. 5
ECG ..................................................................................................................................... 5
Hoofdstuk 2: ECG terminologie en registratie ....................................................................... 6
Nomenclatuur .................................................................................................................... 6
Registratie .......................................................................................................................... 6
Problemen ...................................................................................................................... 6
Elektriciteit vs contractie .................................................................................................... 6
Topografische anatomie..................................................................................................... 7
Anatomische correlatie .................................................................................................. 7
Nut Ecg ............................................................................................................................... 7
Ecg-protocol ....................................................................................................................... 7
Hoofdstuk 3: Ritmestoornissen .............................................................................................. 7
Mechanisme ....................................................................................................................... 7
Antiaritmica ........................................................................................................................ 8
Lidocaïne ........................................................................................................................ 8
Flecainide........................................................................................................................ 8
Amiodarone .................................................................................................................... 8
Dronedarone .................................................................................................................. 9
Adenosiene ..................................................................................................................... 9
Verapamil ....................................................................................................................... 9
Sotalol ............................................................................................................................. 9
Digoxine .......................................................................................................................... 9
Niet-farmacologische behandeling .................................................................................... 9
Normale ECG, hypertrofie en geleidingsstoornissen ............................................................. 10
Inleiding ................................................................................................................................ 10
ECG protocol......................................................................................................................... 10
QRS-as........................................................................................................................... 10
Asbepaling ........................................................................................................................ 10
Normale ECG ................................................................................................................ 11
Abnormale ECG .................................................................................................................... 12
Linker voorkamerhypertrofie ........................................................................................... 12
Rechter voorkamerhypertrofie ........................................................................................ 12
1
, Linker ventrikel hypertrofie.............................................................................................. 13
Rechter ventrikelhypertrofie ............................................................................................ 13
Biventriculaire dilatatie .................................................................................................... 14
Casus................................................................................................................................. 14
Intraventriculaire geleidinsstoornissen............................................................................ 14
Linker bundeltak ........................................................................................................... 15
Rechter bundeltakblok ................................................................................................. 15
Linker anterior en posterior hemiblok ......................................................................... 15
Gevorderde geleidingsstoornissen............................................................................... 15
Bradycardie....................................................................................................................... 16
Sinusknoop gerelateerde bradycardie ......................................................................... 16
AV blok ......................................................................................................................... 16
Pacemaker .................................................................................................................... 18
Casus................................................................................................................................. 19
Cardiale ischemie ..................................................................................................................... 19
Pathofysiologie van ECG manifestatie ................................................................................. 20
Subendocardiale vs. Transmurale ischemie ..................................................................... 20
Ischemie vs necrose ......................................................................................................... 20
Evolutie ............................................................................................................................. 21
Hyper-acute fase .......................................................................................................... 21
Recent stemi ................................................................................................................. 21
Oud MI .......................................................................................................................... 21
Q-golf ................................................................................................................................ 22
ST-segment depressie ...................................................................................................... 22
Instabiele angor ................................................................................................................ 22
Differentieel diagnose ...................................................................................................... 22
Aflopende ST depressie ................................................................................................ 22
Negatieve T’s ................................................................................................................ 22
Definitie van infarct .......................................................................................................... 23
Anatomie .......................................................................................................................... 23
Voorwand infarct.......................................................................................................... 23
Onderwand infarct ....................................................................................................... 23
Achterwand infarct....................................................................................................... 23
DD/ ................................................................................................................................... 24
ST segment elevatie ..................................................................................................... 24
2
, DD/ ST segment depressie ........................................................................................... 24
Hoge R-golf in VI ........................................................................................................... 24
Zwakke R-progressie .................................................................................................... 24
Hyperkalemie ................................................................................................................... 25
Hypokalemie ..................................................................................................................... 25
Digitalis effect ................................................................................................................... 25
Acute pericarditis ............................................................................................................. 25
Vroege repolarisatie ..................................................................................................... 26
Brugada syndroom ....................................................................................................... 26
Preexctitatie ..................................................................................................................... 26
Proximale LAD stenose ..................................................................................................... 26
Hoofdstamletsel ............................................................................................................... 26
Casus..................................................................................................................................... 26
Patiënt 1 ........................................................................................................................... 26
Patiënt 2 ........................................................................................................................... 27
Ritmestoornissen ..................................................................................................................... 27
Onderverdeling..................................................................................................................... 27
Obv onderverdeling ECG .................................................................................................. 27
Obv onderliggend pathofysiologisch mechanisme .......................................................... 28
Anamnese ......................................................................................................................... 28
Specifieke ritmestoornissen ................................................................................................. 28
Escape ritme en extrasystole ........................................................................................... 28
Atriale extrasystole....................................................................................................... 28
Ventriculaire extrasystolen .......................................................................................... 29
Verhoogde/abnormale automaticiteit ............................................................................. 31
Sinus tachycardie.......................................................................................................... 31
Ectopische tachycardie ................................................................................................. 32
Voorkamerfibrillatie ............................................................................................................. 32
Pathofysiologie ................................................................................................................. 33
Symptomen ...................................................................................................................... 33
Prevalentie ....................................................................................................................... 33
Patiënt met VKF ................................................................................................................ 34
C: RF inschatten ............................................................................................................ 34
A: Thrombo-embolisch risico ....................................................................................... 35
Reductie S/ door rate en rythm control ....................................................................... 39
3
2025
ECG
PROF DR WILLEMS
JOZEFIEN CEULEMANS
,ECG zelfstudie ............................................................................................................................ 5
Hoofdstuk 1: fysiologie en technische achtergrond .............................................................. 5
Actiepotentialen ................................................................................................................. 5
Vector ................................................................................................................................. 5
ECG ..................................................................................................................................... 5
Hoofdstuk 2: ECG terminologie en registratie ....................................................................... 6
Nomenclatuur .................................................................................................................... 6
Registratie .......................................................................................................................... 6
Problemen ...................................................................................................................... 6
Elektriciteit vs contractie .................................................................................................... 6
Topografische anatomie..................................................................................................... 7
Anatomische correlatie .................................................................................................. 7
Nut Ecg ............................................................................................................................... 7
Ecg-protocol ....................................................................................................................... 7
Hoofdstuk 3: Ritmestoornissen .............................................................................................. 7
Mechanisme ....................................................................................................................... 7
Antiaritmica ........................................................................................................................ 8
Lidocaïne ........................................................................................................................ 8
Flecainide........................................................................................................................ 8
Amiodarone .................................................................................................................... 8
Dronedarone .................................................................................................................. 9
Adenosiene ..................................................................................................................... 9
Verapamil ....................................................................................................................... 9
Sotalol ............................................................................................................................. 9
Digoxine .......................................................................................................................... 9
Niet-farmacologische behandeling .................................................................................... 9
Normale ECG, hypertrofie en geleidingsstoornissen ............................................................. 10
Inleiding ................................................................................................................................ 10
ECG protocol......................................................................................................................... 10
QRS-as........................................................................................................................... 10
Asbepaling ........................................................................................................................ 10
Normale ECG ................................................................................................................ 11
Abnormale ECG .................................................................................................................... 12
Linker voorkamerhypertrofie ........................................................................................... 12
Rechter voorkamerhypertrofie ........................................................................................ 12
1
, Linker ventrikel hypertrofie.............................................................................................. 13
Rechter ventrikelhypertrofie ............................................................................................ 13
Biventriculaire dilatatie .................................................................................................... 14
Casus................................................................................................................................. 14
Intraventriculaire geleidinsstoornissen............................................................................ 14
Linker bundeltak ........................................................................................................... 15
Rechter bundeltakblok ................................................................................................. 15
Linker anterior en posterior hemiblok ......................................................................... 15
Gevorderde geleidingsstoornissen............................................................................... 15
Bradycardie....................................................................................................................... 16
Sinusknoop gerelateerde bradycardie ......................................................................... 16
AV blok ......................................................................................................................... 16
Pacemaker .................................................................................................................... 18
Casus................................................................................................................................. 19
Cardiale ischemie ..................................................................................................................... 19
Pathofysiologie van ECG manifestatie ................................................................................. 20
Subendocardiale vs. Transmurale ischemie ..................................................................... 20
Ischemie vs necrose ......................................................................................................... 20
Evolutie ............................................................................................................................. 21
Hyper-acute fase .......................................................................................................... 21
Recent stemi ................................................................................................................. 21
Oud MI .......................................................................................................................... 21
Q-golf ................................................................................................................................ 22
ST-segment depressie ...................................................................................................... 22
Instabiele angor ................................................................................................................ 22
Differentieel diagnose ...................................................................................................... 22
Aflopende ST depressie ................................................................................................ 22
Negatieve T’s ................................................................................................................ 22
Definitie van infarct .......................................................................................................... 23
Anatomie .......................................................................................................................... 23
Voorwand infarct.......................................................................................................... 23
Onderwand infarct ....................................................................................................... 23
Achterwand infarct....................................................................................................... 23
DD/ ................................................................................................................................... 24
ST segment elevatie ..................................................................................................... 24
2
, DD/ ST segment depressie ........................................................................................... 24
Hoge R-golf in VI ........................................................................................................... 24
Zwakke R-progressie .................................................................................................... 24
Hyperkalemie ................................................................................................................... 25
Hypokalemie ..................................................................................................................... 25
Digitalis effect ................................................................................................................... 25
Acute pericarditis ............................................................................................................. 25
Vroege repolarisatie ..................................................................................................... 26
Brugada syndroom ....................................................................................................... 26
Preexctitatie ..................................................................................................................... 26
Proximale LAD stenose ..................................................................................................... 26
Hoofdstamletsel ............................................................................................................... 26
Casus..................................................................................................................................... 26
Patiënt 1 ........................................................................................................................... 26
Patiënt 2 ........................................................................................................................... 27
Ritmestoornissen ..................................................................................................................... 27
Onderverdeling..................................................................................................................... 27
Obv onderverdeling ECG .................................................................................................. 27
Obv onderliggend pathofysiologisch mechanisme .......................................................... 28
Anamnese ......................................................................................................................... 28
Specifieke ritmestoornissen ................................................................................................. 28
Escape ritme en extrasystole ........................................................................................... 28
Atriale extrasystole....................................................................................................... 28
Ventriculaire extrasystolen .......................................................................................... 29
Verhoogde/abnormale automaticiteit ............................................................................. 31
Sinus tachycardie.......................................................................................................... 31
Ectopische tachycardie ................................................................................................. 32
Voorkamerfibrillatie ............................................................................................................. 32
Pathofysiologie ................................................................................................................. 33
Symptomen ...................................................................................................................... 33
Prevalentie ....................................................................................................................... 33
Patiënt met VKF ................................................................................................................ 34
C: RF inschatten ............................................................................................................ 34
A: Thrombo-embolisch risico ....................................................................................... 35
Reductie S/ door rate en rythm control ....................................................................... 39
3
