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2016 | OriginalPaper | Hoofdstuk
28. Pijn op de borst
Auteurs : H. C. P. M. van Weert, R. J. G. Peters, H. G. L. M. Grundmeijer
Gepubliceerd in: Diagnostiek van alledaagse klachten
Uitgeverij: Bohn Stafleu van Loghum
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Samenvatting
Pijn op de borst komt vaak voor en lang niet alle mensen gaan ermee naar de dokter. Bij degenen die wel komen, gaat het in meer dan de helft van de gevallen om relatief onschuldige aandoeningen. Het is echter voor de huisarts en de SEH-arts van belang om zo snel mogelijk en met een zo groot mogelijke zekerheid cardiale ischemie, longembolie, dissectie van de aorta en pneumothorax uit te sluiten. Alle genoemde aandoeningen vereisen immers snel handelen.Wat betreft cardiale ischemie is de anamnese het belangrijkste instrument. De negatief voorspellende waarde ervan is, zeker bij een populatie met een lage a-priorikans, zeer groot. De aard van de pijn en bijkomende symptomen, de aanwezigheid van risicofactoren en een cardiale voorgeschiedenis beïnvloeden de kans op een acuut coronair syndroom (ACS), maar er is geen combinatie van anamnestische verschijnselen en bevindingen bij lichamelijk onderzoek die een acuut coronair syndroom kan aantonen of volledig kan uitsluiten. Een ECG tijdens de pijn is buitengewoon behulpzaam voor het in- en het uitsluiten van een ACS. Sluitend bewijs voor myocardschade heeft men pas in handen na markerbepalingen. Angina pectoris blijft een anamnestische diagnose. Bij diagnostische twijfel staan verschillende diagnostische strategieën ter beschikking.
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Metagegevens
- Titel
- Pijn op de borst
- Auteurs
-
H. C. P. M. van Weert
R. J. G. Peters
H. G. L. M. Grundmeijer
- Copyright
- 2016
- Uitgeverij
- Bohn Stafleu van Loghum
- Boek
-
Diagnostiek van alledaagse klachten
Print ISBN: 978-90-368-1154-5
Elektronisch ISBN: 978-90-368-1274-0
Copyright: 2016
- DOI
- https://doi.org/10.1007/978-90-368-1274-0_28