NHG-Richtlijnen
NHG-Standaard
M103
3.1
In herziening
augustus 2022
december 2024
K. Hart-vaatstelsel

Richtlijnen diagnostiek

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Eerste (telefonische) contact

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ABCDE stabiel

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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Evaluatie

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Richtlijnen beleid acute fase

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Uitvalsverschijnselen aanwezig, < 12 uur geleden ontstaan (U1, spoed)

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Uitvalsverschijnselen aanwezig, ≥ 12 uur geleden ontstaan (U2, < 1 uur)

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Uitvalsverschijnselen aanwezig: infauste prognose of wens thuis te blijven (U2, < 1 uur)

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Uitvalsverschijnselen volledig verdwenen (U3, binnen enkele uren)

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Richtlijnen beleid na ontslag

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Overdracht van tweede lijn naar huisarts

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Aandachtspunten

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Voorlichting

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Medicamenteuze onderhoudsbehandeling

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Controles

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Consultatie en verwijzing

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Belangrijkste wijzigingen

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Kernboodschappen

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Inleiding

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Scope

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Buiten de scope

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Afstemming

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Achtergronden

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Begrippen

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Epidemiologie

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Etiologie en pathofysiologie

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TIA en herseninfarct

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Intracerebrale bloeding

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Beloop en prognose

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Restverschijnselen

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Neuropsychologische functiestoornissen na herseninfarct of intracerebrale bloeding

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Neuropsychologische functiestoornissen na TIA

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Behandelingsmogelijkheden

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Opname op een stroke unit

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Intraveneuze trombolyse

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Endovasculaire behandeling

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Secundaire preventie

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Carotisdesobstructie
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Revalidatie na herseninfarct of intracerebrale bloeding

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Oefen- en ergotherapie
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Logopedie
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Richtlijnen diagnostiek

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Eerste (telefonische) contact

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FAST-test (Face-Arm-Speech-Time-test)
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Anamnese

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Lichamelijk onderzoek

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Aanvullend onderzoek

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Predictiemodel

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Evaluatie

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Acuut dubbelzien
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Richtlijnen beleid acute fase

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Uitvalsverschijnselen aanwezig, < 12 uur geleden ontstaan (U1, spoed)

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Uitvalsverschijnselen aanwezig, ≥ 12 uur geleden ontstaan (U2, < 1 uur)

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Uitvalsverschijnselen aanwezig: infauste prognose of wens thuis te blijven (U2, < 1 uur)

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Uitvalsverschijnselen volledig verdwenen (U3, binnen enkele uren)

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ABCD²-score
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Richtlijnen beleid na ontslag

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Overdracht van tweede lijn naar huisarts

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Aandachtspunten

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Behandeling

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Barthelindex
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Neuropsychologisch
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MoCA
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Maatschappelijk functioneren

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Mantelzorg

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Voorlichting

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Leefstijladviezen
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Rijgeschiktheid

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Seksualiteit

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Thuisarts

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Medicamenteuze onderhoudsbehandeling

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Na TIA of herseninfarct

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Trombocytenaggregatieremmers
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Orale anticoagulantia
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Cholesterolverlagende medicatie
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Antihypertensiva
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Beleid na een herseninfarct als gevolg van arteriële dissectie
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Na een intracerebrale bloeding

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Trombocytenaggregatieremmers
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Anticoagulantia
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Antihypertensiva
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Cholesterolverlagende medicatie
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Controles

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Consultatie en verwijzing

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CVA ketenzorg

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Referenties

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NHG-werkgroep:
Dolmans LS, Hegeman LF, Tjon-A-Tsien MRS, Van den Donk M, Van Noortwijk-Bonga HGC, Verburg-Oorthuizen AFE, Wiersma Tj.
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