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1- Cardiovascular diseases Flashcards

1
Q

What are the 3 types of microbial infections of endocardium/heart valves?

A
  • Bacterial infections
  • Fungal infections
  • Viral infections
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2
Q

How are the infections of endocarditis classified?

A

1.) by organisms causing the infection
2.) Type of valves being infected
3.) The source of infection

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3
Q

What are the risk factors associated with these infections?

A

1.) Damaged heart valves
2.) Artificial heart valves
3.) Congenital heart defects
4.) History of endocarditis
5.) History of IV drug use

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4
Q

What are the clinical presentations of infective endocarditis?

A

1.) Fever
2.) Heart murmur
3.) Extremities

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5
Q

What is the clinical result from the immune system detecting & trying to combat pathogens?

A

Fever

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6
Q

What is the clinical presentation that results in disruption in blood flow in the heart, valves not completely closing, & backflow of blood (turbulence which can auscultated)

A

Heart murmur

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7
Q

What are the 4 types of clinical presentations underlying extremities?

A

1.) Osler nodes
2.) Janeway lesiokns
3.) Spinter hemorrhages
4.) Nail clubbing

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8
Q

What are raised red lesions on hands & feet know as?

A

Osler nodes

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9
Q

What are flat papules on palms of hands or soles of feet recognized as?

A

Janeway lesions

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10
Q

What are streaks of blood under fingernails known as?

A

Splinter hemorrhages

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11
Q

What are enlargement of finger tips known as?

A

Nail clubbing

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12
Q

What are the oral presentations of infective endocarditis?

A

Petechiae (found on the palatal & mucosa)

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13
Q

What are the dental management steps for infective endocarditis?

A

1.) Bleeding & bacteremia
2.) Antibiotic prophylaxis
3.) Treatment planning

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14
Q

What can dental hygiene treatment induce in people with infective endocarditis?

A

They can result in transient bacteremia, further increasing the risk factors for patients with infective endocarditis

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15
Q

What is the hypothesis of treating bacteremia in infective endocarditis?

A

That antibiotic prophylaxis will reduce bacteremia & therefore decrease the risk of infective endocarditis

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16
Q

What are the recommended doses & instructions of antibiotic prophylaxis in people with infective endocarditis?

A

1.) Single dose 30-60 minutes prior to the appointment
2.) May be given up to 2 hr after procedure if not given prior beforehand

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17
Q

What are the treatment planning recommendations for infective endocarditis?

A

1.) Antibiotic prophylaxis
2.) Emphasis on optimized oral health to reduce bacterial burden
3.) Appointment scheduling:
- appts > 6hrs may need additional prophylactic antibiotics
- allow at least 10 days between sessions (clearance of antibiotic resistant organisms from oral cavity)

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18
Q

What are the common ways the bacteria can enter in the body to induce a potential case of infective endocarditis?

A

Via the mouth or intravenously

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19
Q

What will occur if the bacteria adheres to an area that is injured or inflamed?

A

The bacteria will persist in this particular area through adherence & will eventually proliferate & disseminate to leave to other areas of the body

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20
Q

What similiar role does dissemination have when it leaves the area proliferation to transport itself to other areas of the body?

A

It can induce a blood clotting role in other areas of the body.

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21
Q

when would we recommend antibiotic prophylaxis for individuals with infective endocarditis?

A

When these individuals have:
1.) Prosthetic cardiac valve
2.) Previous infective endocarditis
3.) Congenital heart disease

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22
Q

What type of dental procedures would we require a patient to have taken an antibiotic prophylaxis prior to treatment?

A

Dental procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa

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23
Q

Are dental procedures such as routine anesthetics, dental radiographs, placement of removal prosthondontic/orthodontic appliances call for a need of an antibiotic prophylaxis?

A

No they do not require an antibiotic prophylaxis as they do not involve manipulation of the gingival tissue or periapical region of teeth/perforstion of the oral mucosa

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24
Q

How much amoxicillin will be given ORALLY to an ADULT 30-60 minutes before a procedures

A

2g (2 grams)

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25
How much amoxicillin will be given ORALLY to a CHILD 30 - 60 minutes before a procedure?
50mg/kg
26
If the patient cannot take the antibiotic via oral administration, what would we be the other alternative?
Via intravenous or intramuscular administration.
27
What are the agents used if oral administration cannot be given?
Ampicillin + Cefazolin Ceftriazone
28
How much Cefazolin/Ampicillin IV/IM is given to an ADULT 30-60 mins prior to an appointment?
2g IM or IV
29
How much Ceftriaxone IV/IM is given to an ADULT 30-60 mins prior to an appointment?
1g IM or IV
30
How much Amipicillin/ Cefazoline or Ceftriazone IV/IM is given to a CHILD 30-60 mins prior to an appointment?
50mg/kg IM or IV
31
What are the alternative agents given to a patient when they are allergic to penicillins or ampicillins, but can be administered ORALLY?
Cephalexin, clindamycin & clarithormycin
32
What are the alternative agents given to a patient when they are allergic to penicillins or ampicillin, and must be administered INTRAVENOUSLY or INTRAMUSCULARLY?
Cefazolin, ceftriaxone & clindamycin
33
How much cephalexin ORALLy can be given to an adult 30-60mins prior to an appointment?
2g (2 grams) / 50mg/kg
34
How much clindamycin ORALLY & IV/IM can be given to an adult 30-60 mins prior to an appointment?
600 mg / 20mg/kg
35
how much clarithromycin ORALLY & IV/IM can be given to an adult 30-60 mins prior to an appt?
500mg / 15mg/kg
36
How much cefazoline/ceftriaxone can be given to an ADULT & CHILD via IM/IV?
1g for an adult / 50mg/kg for a child
37
How much clinadymycin can be given to an ADULT & CHILD via IM/IV?
600 mg for an adult / 20mg/kg IM or IV
38
What is another word of hypertension & what is the basis of its physiology?
it is known as high blood pressure. It is due to the persistently elevated blood pressure which is often non-symptomatic but can cause organ damage.
39
Why can it be considered "non-symptomatic"?
Due to the unawareness that individuals might have towards hypertension & that people who are on medications may not have adequate control over their BP.
40
How is hypertension measured in?
Systolic & diastolic
41
What does the pathophysiology of hypertension consist of?
1.) Mechanisms involving increase in cardiac output & peripheral resistance 2.) Abnormal sodium transport 3.) Increased vasoconstrictor 4.) Deficiency in vasodilators
42
What are the two main mechanisms used in control of hypertension?
Cardiac output & peripheral resistance
43
How would an abnormal sodium transport occur?
It would occur due to an increase in intracellular sodium, making the cell more sensitive to sympathetic stimulation (increasing heart rate)
44
What is responsible for the increase in vasoconstriction?
renin-angiotensin-aldosterone systems
45
What is responsible for a deficiency in vasodilation in hypertension?
the bradykinin & nitric oxides
46
T or F <120 SBP + <80 DBP are considered normal BP
True
47
According to the JNC, when a patient has a SBP/DBP of 120-139/80-89, what kind of BP are they considered to have?
Prehypertension
48
According to the JNC, when a patient has a SBP/DBP of 140-159/90-99, what kind of BP are they considered to have?
Stage 1 hypertension
49
According to the JNC, when a patient has a SBP/DBP of >160/>100, what kind of BP are they considered to have?
Stage 2 hypertension
50
What are the types of managements used for hypertension?
Lifestyle changes + phamacological interventions
51
What kind of lifestyle changes would be required to manage hypertension?
Weight loss Diet Exercise
52
What kind of pharmacological interventions are needed to manage hypertension?
Diuretics Beta blockers ACE inhibitors Calcium channel blockers
53
What are the dental managements needed when a patient is classified under ASA I?
safe to proceed with tx encourage client to see physician slightly elevated BP
54
What are the dental managements needed when a patient is classified under ASA II?
safe to proceed with tx encourage visit to physician CONTINUOUSLY monitor BP moderately elevated BP
55
What occurs when a patient is classified to be an ASA III & IV?
INITIATE a medical consult NO dental treatment will be done Take & record BP provide warm blanket Encourage patient to see their physician ASAP
56
What are some treatment planning considerations needed for an individual with hypertension?
- Establish good rapport stress/anxiety reduction (premed with sedatives + use of NO/O2 - short morning appointments -cautious use of epinephrine - consider periodic intraoperative BP monitoring - Slow chair position changes
57
How can cardiac output be impacted?
By heart rate + Stroke volume
58
What controls the peripheral resistance in hypertension?
1.) Blood vessel diameter 2.) The vessel elasticity 3.) Blood viscosity 4.) Total blood volume
59
What is an ischemic heart disease?
It is also known as a coronary artery disease. occurs due to a REDUCTION in blood flow to the vessels that supply the muscle tissue of the heart.
60
How does an ischemic heart disease typically occur?
It typically occurs due to a NARROWING of the coronary arteries.
61
Name the risk factors by which can be associated to ischemic heart disease.
1.) Male 2.) Older age 3.) Genetics 4.) Hyperlipidemia 5.) Hypertension 6.) Smoking 7.) Physical inactivity 8.) Obesity 9.) Diabetes mellitus 10.) Stress. 11.) Depression
62
What is the pathophysiology of an ischemic heart disease?
1.) It being with depositions of fatty plaques in coronary arteries by which break off in the circulation (embolism)
63
What can an embolism cause in a blood circulation?
It can block/restrict the vessels, making them smaller (constricting)
64
What can embolism ultimately lead to?
myocardial infarction (heart attack) or cardiac arrest
65
myocardial infarction is a ______ or _______ of blood to an area of the heart, damaging the heart muscles.
Decrease, cessation
66
What are the common symptoms of ischemic heart diseases in males?
1.) Pain in left arm 2.) Cold sweats 3.) Squeezing of chest
67
What are the common symptoms of heart attacks in both males & females?
1.) Chest pressure 2.) Pain spreading to the neck, shoulder & jaw
68
What are the common symptoms of heart attacks in females?
1.) Lower chest pain 2.) Back or jaw pain 3.) Unexplained fatigue/anxiety 4.) Nausea 5.) Shortness of breath 6.) Palpatations 7.) dizziness
69
How does angina occur?
- from a TEMPORARY disruption to blood flow to the heart - Does not cause permanent damage - May be a harbinger of myocardial infarction.
70
What are the medical managements of ischemic heart diseases?
1.) Angioplasty/stent 2.) Coronary artery bypass grafts 3.) Phamacological agents
71
What are some of the phamacological agents used to manage heart diseases?
1.) Aspirin 2.) Beta blockers 3.) Calcium channel blockers 4.) Statins 5.) ACE inhibitors
72
What are some dental managements used to treat heart diseases?
1.) No direct effect to oral cavity 2.) Meds may have oral side effects 3.) Readiness for medical emergencies - Nitroglycerine: vasodilator - Oxygen - ASA-aspirin - Cardiopulmonary resuscitation (CPR): Automated external defibrillator (AED)
73
What are some treatment planning considerations taken with heart diseases?
1.) Stress reduction 2.) Scheduling: short, morning appts 3.) Bleeding: patients taking anticoagulants may have prolonged bleeding times 4.) Anesthesia: ensuring adequate pain managements during & after appts. Limit use of epinephrine.
74
What is a cardiac arrhythmia?
It is an irregular or abnormal heartbeats.
75
how can cardiac arrhythmias arise?
From: 1.) Coronary artery disease 2.) Cardiomyopathy 3.) Injury to cardiac muscle 4.) Valve disorders 5.) Electrolyte imbalances in the blood 6.) Nervous system irregularities 7.) Genetics
76
What is bradycardia?
When there is a SLOWER normal resting heart rate (e.g: <60 bpm resting heart rate)
77
What is tachycardia?
When there is a FASTER than normal resting heart rate (e.g: >100bpm resting heart rate)
78
What are 3 types of heart rhythm abnormalities?
1.) Premature contractions 2.) Fibrillation: Atrial & ventricular 3.) Long QT syndrome: extended time for ventricular systole & higher risk of torsade de pointes
79
What are some medical management used to treat cardiac arrhythmias?
Medications: - sodium channel disruption - calcium channel blockers - beta blockers - anticoagulants Pacemakers: - regulation of heart rate
80
What are dental management considerations needed for cardiac arrhythmias?
interference with pacemakers: - can interfere with pacemaker function - newer pacemakers have better shielding & less susceptible to interference
81
What are some treatment planning considerations needed for cardiac arrhythmias?
Limit use of vasoconstrictors stress & anxiety managements
82
What is the definition of heart failure?
It is known as congestive heart failure: It is due to the impaired ability of heart to fill (diastolic failure) or eject (sytolic failure) blood
83
How can heart failure be caused by?
1.) Genetic factors 2.) Heart defects/diseases 3.) High BP 4.) Coronary artery diseases
84
What side of the heart affects the blood pump to the lungs?
The right side.
85
What can a right side failure cause in the heart?
Edema in the abdomen, legs venous congestion
86
What side of the heart affects the blood to pump to the body?
The left side.
87
How can left side heart failure be caused by?
By peripheral resistance + weakened cardiac muscles
88
What can the result of left side heart failure?
Can result in pulmonary hypertension
89
What are some main symptoms caused by right heart failure?
1.) Congestion of peripheral tissues: a.) liver congestion b.) GI tract congestion c.) edema + ascites
90
What are some main symptoms caused by left heart failure?
1.) Decrease in cardiac output 2.) Pulmonary congestion a.) Pulmonary edema - orthopnea -cough with frothy septum - paroxysmal nocturnal dyspnea b.) impaired gas exchange - cyanosis + signs of hypoxia
91
What are some medical managements used for heart failures? (p.8 :lecture 5)
1.) Diuretics 2.) ACE inhibitors 3.) Beta blockers 4.) Anticoagulants
92
What are some dental management steps taken for heart failure?
Risk assessment: - decompensated - NYHA class I, II, III, IV are NOT candidates for elective treatment
93
What are some MAJOR risk factors for serious incident in heart failure patients?
Myocardial infarction Unstable angina sudden death
94
What are some treatment planning considerations needed for heart failure patients?
1.) Be cognizant of anxiety levels 2.) Anesthesia & analgesia: reduce pain + monitor epinephrine 3.) Potential for increased bleeding if on anticoagulants 4.) Continous blood pressure monitoring 5.) Chair position: supine position may not be tolerated, so put them in a semi-supine position.

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